1. Undergraduate Admission Application
Application #: W00000000004737
Date Created: Date Submitted: Signed By:
PERSONAL INFORMATION
Name (as it appears on official documents)
basalasil waleed A Sr
Last First Middle Former/Maiden Suffix
Social Security Number: '***-**- Gender: Male Female
Date of Birth: 01/24/1987 Birth City:riyadh Birth State:Foreign Country Birth Country:Saudi Arabia
Are you a U.S. Citizen? Yes No
Non U.S Citizens Only: Are you a Permanent Resident? Yes No
Do you currently hold a U.S. Visa? Yes No Visa Type : F1
Country of Citizenship:Saudi Arabia
Residency? I am currently living in Ohio and have lived in Ohio for the past 12 consecutive months or more
Please provide background on both your ethnicity and race. This information will be used for reporting purposes only.
Ethnicity: Are you Hispanic/Latino? Yes No
Race: Select one or more races that describe you best:
American Indian or Alaska Native Asian Black or African American
Native Hawaiian or Other Pacific Islander White
Have you ever pled guilty or been convicted of a criminal offense or have charges pending against you?
Yes No (At all times as an applicant or a student, you are required to notify the Dean of Students if a plea, conviction or charges pending occur.)
Explanation:
Have you ever been dismissed, suspended or placed on probation by any other college, university or high school for a NON-ACADEMIC reason?
Yes No
Explanation:
CONTACT INFORMATION
Home Address
1701 E 12th street apt 21o cleveland ERIE OH United States 44114
Street Address City County (Ohio) State Country Zip Code
E-mail Address: wb1406@hotmail.com Home Phone: 2163346801 Work Phone: Cell Phone:
Would you like to receive important news and information from Cleveland State University via text message? Yes No
EMERGENCY CONTACT
Please indicate the nearest relative or person to contact in case of emergency.
What is this persons relationship to you? Parents Father Mother Guardian Spouse Relative Other
omar albahar 216334681
Name Phone Alternate Phone
Address same as above: Yes

2. ENROLLMENT PLANS
Application Type: Undergraduate
Degree Type: Degree
Name of Program: Business Administration
Entrance Term: Spring Semester 2013
EDUCATION HISTORY
GED High School
Graduation Date or GED Date: 02/2006
High School Name City State Country
king fahad high school riyadh FC Saudi Arabia
Will you have completed a four-year college bachelor's degree prior to your expected enrollment term at CSU? Yes No
Have you attended any college or university other than Cleveland State University? Yes No
College Name Enrolled? Awd/Exp? Degree Degr Date Major Other Deg Hrs Earned Last Atntd? Attnd Fr/To
Cleveland State University N Y /-
(Cleveland,OH,USA) /
(2293418) Cleveland,OH USA
ADDITIONAL INFORMATION
Would you like information about financial aid? Yes No
Has your mother/father/guardian earned a four year bachelors degree from a college or university? Mother/Guardian Father/Guardian
Is your mother/father/guardian a graduate of Cleveland State University? Mother/Guardian Father/Guardian
Do you plan to live on campus? Yes No Undecided
Are you a United States military veteran or currently serving in the military? Yes No
Essay/Personal Statement
FERPA Statement
The Family Education Rights and Privacy Act of 1974 permits Cleveland State University to release directory (public) information about students.
Directory (public) information includes the student's name, home, mailing and email addresses, telephone number, major field of study, participation in
officially recognized activities and sports, height and weight for members of athletic teams, dates of attendance, degrees earned and awards (honors)
earned, and most recent previous educational institution attended.
Students have the right to restrict the release of directory information. If the release of directory information is restricted, it must be noted that the
information will be withheld from ALL third parties. Such third parties include prospective employers, honor societies, the news media, relatives, friends
and all others. It is important to carefully consider the potential consequences of restricting the release of directory information.
I do not wish to restrict the release of my directory information at this time.
I wish to restrict the release of my directory information. I understand that my information will be withheld from ALL sources until this restriction is
retracted by me.