This document is an international student application form that collects personal information such as name, date of birth, citizenship, contact details, English proficiency, high school and college details, parents' education level, and certification of accuracy of the information provided. It requests payment by credit card for the student's program.

1. INTERNATIONALAPPLICATIONFORM
Country of citizenship: Country of birth: City of birth:
Type of degree:
Country of citizenship: Have you graduated from high school?
Have you attempted 12 or more semester credit hours of college credit since graduating from high school?
PERSONALINFORMATION
First/ Given Name:
Middle Name: Previous Last Names:
ENGLISH PROFICIENCY
Gender:
CONTACTINFORMATION
CURRENT MAILING ADDRESS
Street 1:
Street 2:
City:
Country:
Zip Code:
MOTHER OR GUARDIAN’S NAME
First Name:
Visa type: Application Term:
Preferred (First) Name: Last/ Family Name:
Suffix (Jr., Sr., III, etc): Date of Birth (yyyy/mm/dd):
Is English your native language? What is your native language?
How will you verify English Proficiency?
State:
Province (if not USA):
Street 1:
Street 2:
City:
Country:
Zip Code:
State:
Province (if not USA):
Phone:
Last Name:
Yes No
Yes No
IELTS TOEFL Others:
Yes No
No If Yes, please provide details of when the application was lodged and outcome.
IS THIS PARENT/GUARDIAN’S MAILING ADDRESS THE SAME AS YOURS?
Mother or Guardian’s Phone: Email Address:
Father or Guardian’s Phone:
Email Address:
FATHER OR GUARDIAN’S NAME
First Name: Last Name:
IS THIS PARENT/GUARDIAN’S MAILING ADDRESS THE SAME AS YOURS? Yes No
If no, please indicate:
INTERNATIONALAPPLICATIONFORM
Have you previously submitted an application to study at University of Nebraska–Lincoln?
PREVIOUSAPPLICATION

2. HIGHSCHOOLINFORMATION
ABOUT HIGH SCHOOL RECORDS
An official transcript is required.
Your application cannot be processed until the transcript is received.
WHAT HIGH SCHOOL DID/WILL YOU GRADUATE FROM?
High School Name:
High School City:
GRADUATION DATE
Month:
COLLEGEINFORMATION
COLLEGE RECORDS
List below all institutions where you have attempted and/or completed classes including dual credit.
Failure to disclose all institutions attended is a violation if the UNL student code of conduct and may lead to revocation of your admission status.
Have you received a bachelor’s degree before?
ADDITIONALINFORMATION
Are either of your parents currently enrolled or an alumni of the University of Nebraska System
(UNL, UNO, UNK, UNMC, Kearney State College or University of Ohama)?
Have either of your parents graduated from a 4-year college or university?
What levels of education haveyour parents completed?
Parent 1:
Year:
High School Country:
High School State:
IS THIS HIGH SCHOOL LOCATED OUTSIDE OF THE UNITED STATES AND ITS TERRITORIES?
WHAT HIGH SCHOOL GRADES DID/WILL YOU ATTEND?
Leaving Certificate:
Parent 2:
Yes No
Freshman Sophomore Junior Senior
WHAT COLLEGES HAVE YOU ATTENDED?
Yes No
Yes No
ACADEMICS
Please identify the program to which you are applying:
Undeclared Academic Options
Please select 'Undeclared-EXP' if you are undecided on a major. You will receive advising and individual major exploration assistance from
professional academic advisers in the Exploratory and Pre-Professional Advising Center
Pre- Health Academic Options
Please select 'Pre-Health' if you are interested in pursuing a health career in medicine, dentistry, nursing, pharmacy, physical therapy, physician,
assistant, etc. and have not decide on an academic major. You will receive advising guidance from the Exploratory and Pre-Professional
Advising Center. If you know what academic major you want to pursue, please select that major.
Graduate Program Program Name:
Yes No
CERTIFICATION
All documents submitted to University of Nebraska-Lincoln for admission purposes become the property of the University.
Documents will not be released to students nor will they be forwarded to other educational institutions or agencies.
Applicants for admission must submit a bank statement or letter indication sufficient financial resources for their first year of enrollment at the
University of Nebraska-Lincoln.
UNL Admissions requires that you write your name, NUID number and the type of financial support being declared on the bank statement you submit to
our office. If not otherwise indicated, UNL Admissions will accept bank statements as family funds in support of your education.
Scholarship letters must include your name and the name of sponsoring institution.
I certify the information provided on this application is complete and accurate to the best of my knowledge and understand
that any misrepresentation or omission regarding enrollment in other institutions may void my application or result in dismissal.
Signature: Date:
Undergraduate Program Program Name:

3. CREDITCARDPAYMENTREQUEST
Card Type: VISA MASTER
Card Number:
Name of the Card Holder:
Amount of Payment: $
Card Expiry (yyyy/mm/dd):
CVV (three-digit # printed at the back of the card):
STUDENTINFORMATION
Student Name:
Program Name:
Program Start Date (yyyy/mm/dd):
Student Number:
Signature: Date:
CREDITCARDPAYMENTREQUESTFORM