Personal Information

Family (Last) Name *

Please enter your last name

Given (First) Name *

Please enter your first name

Middle

Gender

Permanent Home Address *

Please enter your address

  City/State/Prefecture *

Please enter your city/state

  Postal Code *

Please enter your postal code

  Country *

Please enter your country

Address in U.S. (If applicable)

  City/State

  Zip Code

Home Telephone *
(Include country and city codes)

Please enter your home phone

Work Telephone

Local (U.S.) Telephone (If applicable)

E-mail Address *

Please enter your email

Date of Birth *

/ /

Birth Place *

Please enter your birth place

Country of Citizenship *

Please enter your citizenship

Emergency Contact Information

Family (Last) Name *

Please enter your contact last name

Given (First) Name *

Please enter your contact first name

Relationship to you: *

Please enter your relationship

Address

  City/State/Prefecture

  Postal Code

  Country

Home Telephone

Work Telephone

E-mail Address

Is this individual allowed to communicate with us on your behalf?

If No, name of another individual who is allowed to communicate with us on your behalf

Education

Secondary School

Name *

Please enter your secondary school

Location (City/State/Country) *

Please enter the location

Dates Attended *

Please enter the dates attended

Graduation Date *

Please enter your graduation date

Post Secondary School

Name

Location (City/State/Country)

Dates Attended

Graduation Date

Additional School

Name

Location (City/State/Country)

Dates Attended

Graduation Date

Have you ever been placed on probation, suspended or dismissed from any previous institution? *

Please answer this question

If yes, please explain:

Employment Information

Employment 1

Employer:

Position:

Address

  City/State/Prefecture

  Postal Code

  Country

Employment 2

Employer:

Position:

Address

  City/State/Prefecture

  Postal Code

  Country

Enrollment Information

Applying to Point Park University:

Year: *

Please enter your enrollment year

Term: *

Please select your term

Housing Plans: *

Please select your housing plans

Visa Information

All students applying from within the United States only must complete this section.

What type of visa do you currently hold? *

Please enter your visa type

Admission Number (Form I-94)

Institution that issued the I-20 Form (For F-1 visa holders transferring to Point Park)

SEVIS ID Number (if available)

Standardized Test Scores

TOEFL/IELTS

 Score:

 Test Date:

SAT/ACT

 Score:

 Test Date:

GMAT

 Score:

 Test Date:

GRE

 Score:

 Test Date:

Please make arragements with ETS (Educational Testing Service at www.ets.org ) to send original test scores directly to Point Park University.

Point Park University Institutional Code is 2676.

Admission Information

Please indicate how you heard about Point Park University

Academic Programs

Personal Statement

I hereby certify that I have answered all questions on this application accurately to the best of my ability.