Application

Please complete using Roman alphabet ONLY.

Application is for semester beginning *
Promo code (optional)
How did you hear about UCA?
Referral Name
Email Address of Referring Entity/Person
Family Name or Surname (as shown on your passport) *
First name or Given Name (as shown on your passport) *
Middle Name (as shown on your passport) *

If none, write "NONE".
Date of Birth * / MM / DD YYYY
Note: Please list in Month/Day/Year format.
Country of Birth *
Country of Citizenship *
Gender * Male Female Other/Unknown
Ethnicity (optional) Hispanic/Latino Non-Hispanic/Latino
Please select one. (optional) American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Pacific Islander White
Email Address *

NOTE: We will use this email address to contact you regarding your application, pre-arrival and arrival. This email address will also be entered into your student record and will be used to contact you throughout your educational experience at UCA. Therefore, it is imperative that you list an email address that belongs to you, the applicant and future student.
Address in Home Country *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

If no State/Profince/Region, write "NONE". If no Zip/Postal Code, write "00000".
Telephone in Home Country *
Address in US (if applicable)
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Telephone in US (if applicable)
Emergency Contact: * First Last
Relation of Emergency Contact to Applicant: *

For example: Parent, Friend, or Agent
Address of Emergency Contact *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Telephone Number of Emergency Contact *
Email Address of Emergency Contact *
Are you bringing any dependents? Dependents can only be a spouse or children. * None Spouse 1 child 2 children 3 or more children
EDUCATION OBJECTIVE
Have you ever attended UCA before? * Yes No
If yes, and you are applying for undergraduate admission, you must complete an "Application for Readmission". Email internationaladmission@uca.edu. If you are applying for graduate study, please continue completing this application.
If "yes", when did you attend?
Do you intend to earn a degree at UCA? * Yes No
Intended Level of Study *

Intensive English Program - Select this choice if you do not plan to enroll as an undergraduate or graduate student after completing the Intensive English Program. IEP/Undergraduate - Select this choice if you plan to enroll as an undergraduate student after completing the Intensive English Program. Undergraduate - select this option if you plan to pursue an undergraduate (bachelors) degree. Postbaccalaurate - select this option if you have already completed an undergraduate/bachelors degree and plan to pursue a second undergraduate degree or need to take pre-requisites. Graduate - select this option if you plan to enroll as a Graduate student at UCA. Transient/visiting student - select this option if you will be attending UCA for only one semester and do not intend to earn a degree from UCA.
Intended Program of Study *

Select a field of study.
Do you have a current visa? * No Yes
If YES, please choose one: F1 - Student J1 - Visiting student or research scholar F2 - Dependent of F1 J2 - Dependent of J2 H-1B - Temporary worker B1/B2 - Tourist OTHER
Do you want to live on Campus? * Yes (Out of State Tuition will be waived) No
High School Attended *
High school graduation date * / MM / DD YYYY
If you have not graduated high school, please give your anticipated graduation date.
Location of High School (City, Province, Country) *
Have you ever attended a college or university? * Yes No
Are you currently enrolled in a college/university? * Yes No
If you are currently enrolled, what college/university are you enrolled in?
If yes, please list each college or university attended below.

Failure to list a college or university attended may result in dismissal from UCA and/or loss of transfer credits.
Name of College/University
City and Country where College/University is located.
Date entered / MM / DD YYYY
Date departed / MM / DD YYYY
Program of Study
Degree received
Date degree was/will be awarded. / MM / DD YYYY
Name of College/University
City and Country where College/University is located.
Date entered / MM / DD YYYY
Date departed / MM / DD YYYY
Program of Study
Degree received
Date degree was/will be awarded. / MM / DD YYYY
Have you ever been suspended from a college/university? * Yes No
If yes, where and why? *
Test Scores

Official score results from each test must be sent directly to UCA from examinational authority.
TOEFL Score
Date TOEFL taken/will take / MM / DD YYYY
IELTS exam score
Date IELTS exam taken/will take / MM / DD YYYY
SAT exam score (composite)
Date SAT taken/will take / MM / DD YYYY
ACT score
Date ACT taken/will take / MM / DD YYYY
GMAT exam score
Date GMAT taken/will take / MM / DD YYYY
GRE Exam Score
Date GRE Exam taken/will take / MM / DD YYYY
Have you ever been convicted of a felony while in the United States? * No Yes No response
If the answer to the question above is YES please explain.
Financial Support Information
UCA requires proof of financial support from each applicant. This statement must be on file before an I-20 form can be issued. The student's financial sponsor must obtain an official statement (on letterhead with bank seal) from his/her financial sponsor's financial institution which specifies the amount of money available for the student's educational expenses for one academic year of study.

Although only one year of support is required to be documented initially, students and financial sponsors must plan for the entire education.
I have read and understand that I am required to provide documentation of financial support in the required amounts and I have made arrangements for financial support to cover my entire educational career. * Yes No
By entering my name below, I certify that the information continued within this application is true and correct. I understand that misrepresentation of information will be cause for dismissal from UCA and loss of credits earned. If any information on this form changes prior to my enter into UCA, I will notify the Office of International Admissions immediately.
Please enter name *
Date form was completed. * / MM / DD YYYY
The University of Central Arkansas is an affirmative action/equal opportunity institution dedicated to attracting and supporting a diverse student, faculty and staff population through enhanced multicultural learning environments and opportunities. In keeping with its nondiscrimination policy in employment, admissions and other functions and programs, the university considers employees and students on the basis of individual merit and will not discriminate against a person on the basis of gender, race or color, ethnicity, religion, spiritual beliefs, national origin, age, familial status, socioeconomic background, sexual orientation, disability, political beliefs, intellectual perspective, genetic information, military status, or other factors irrelevant to participation in its programs. (Board Policy 502)

Application

Application

EDUCATION OBJECTIVE

If yes, please list each college or university attended below.

Test Scores

Financial Support Information