Roosevelt University International Study Center 2013/14 Application Form

International First Year and Pre-Masters Program

Before completing this application form, please read the following instructions carefully
1.  This application form must be completed in English and all supporting documents must be supplied in English. 2.  Please check boxes where appropriate.  Transcript of grades 1.  Undergraduate applicants must submit official copies of their transcripts showing the final three or four years of secondary education. A schools seal or principals signature must appear on the copy.  The transcript must be translated into English. The translation must be authenticated as a true copy by a notary public or similar official. Certified originals are required prior to arrival at the university. 2.  Pre-Masters applicants must submit an official Course by Course Credential Evaluation (WES, ECE, EP or IERF) for all bachelors- and masters-level study completed outside of the USA. Undergraduate applicants Attach an essay of at least 300 words that will introduce you to your new university community. This should be your own work, but you may write several drafts and use a dictionary. Check your work carefully before submitting the final letter. The university is interested in knowing as much as possible about you. The following are some suggested topics from which to choose. Please feel free to include anything else that you believe would support your application e.g. sports, clubs, hobbies, etc.  Explain why you want to take part in this program and attend a university in the USA.  Describe the most memorable event in your life (positive or negative), and how it changed you.  Describe your activities and responsibilities at home, school, or in your community. Describe your future job or career plans. Pre-Masters MPA applicants Attach a two page, double spaced, 12 font essay that responds to the question: Are there differences between public sector (including non-profit) administration and private sector administration? Applicants must explain how they arrived at their answer(s), including specific examples of differences and similarities. Applicants that have a GPA lower than 3.0 must also submit a resume. Pre-Masters MBA applicants Attach a resume and a personal goal statement detailing interest in the program and strengths that make you a good candidate. Applicants that have a GPA lower than 3.0 must also submit a copy of GRE/GMAT scores. Return this application form and supplemental documents to your local representative or email directly to: rooseveltiscadmissions@studygroup.com Only send files that must be mailed to: Roosevelt University International Study Center 18 S. Michigan Avenue, Gage 211 Chicago, IL 60603 USA

3.  The signatures on page 6 must be the original signature of the appropriate person.

The following items are required for admissions consideration to Roosevelt University ISC:
Completed application form (in full and checked for accuracy) Parent/guardian sign the agreement section on page 6  (for students under 18 years old only). Full transcripts of all your relevant qualifications, translated into  English and authenticated (see details in next column). A recent official copy (within 3 months) of the fee payers bank statement  (in original language and English) indicating adequate funds to support at least one full year of academic study as well as personal expenses. A sponsors letter (if applicable) will be required before I-20 is issued. Copy of TOEFL, IELTS or Password language test score report. Original  TOEFL or IEL TS score report must be sent from the testing site to Roosevelt after the I-20 has been issued. A copy of your passport identification page.  A copy of your current I-20 and visa, if applicable. Student essay (see details in next column). Two letters of recommendation from a school teacher or  academic staff member. All students are required to be properly insured. StudyCare insurance will automatically be added to your booking, unless proof of alternative insurance is provided. (Please attach translated copy in English with your application.)

Roosevelt University International Study Center, 18 S. Michigan Avenue, Gage 211, Chicago, IL 60603, USA rooseveltiscadmissions@studygroup.com isc.roosevelt.edu Admissions Direct Telephone: 312-282-3163

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Application for enrollment

Program Application
International First Year Applicants:
For which pathway are you applying? Business, Mathematics and Pre-Law Which major do you intend to study? Science

Pre-Masters Applicants:
Which masters degree do you intend to study? MBA MSIMC MPA

All Applicants:
Do you currently hold a valid I-20 from another us school? Yes No If yes, please attach a copy of your current I-20 and visa showing I-94 No If yes, please attach a copy of your current non-immigrant visa

Are you currently in the USA on another non-immigrant visa (examples: B-1/B-2, F-2, etc...)? Yes When would you like to start? Spring/Jan Summer/May Fall/Aug

Student Details (not Agent Details)

Family name(s) Title: Mr Nationality Country of citizenship Primary language of instruction to date Home address City Home telephone number Email  Please check this box if you would like to receive special offers and news from Study Group. You can unsubscribe at any time, and your email address remains confidential. State/Province Zip/Postal code Mobile/Cell phone number Country Mrs Miss Ms Other Given name(s) Date of birth (dd/mm/yyyy) Country of birth First language Age Gender: M F

Father/Guardian Details
Father/Guardian family name(s) Relationship to student Country of citizenship Home address City Home telephone number Email State/Province Zip/Postal code Mobile/Cell phone number  Please check this box if this person is your emergency contact. Country Father/Guardian given name(s) Country of birth

Mother/Guardian Details
Mother/Guardian family name(s) Relationship to student Country of citizenship Home address City Home telephone number Email State/Province Zip/Postal code Mobile/Cell phone number  Please check this box if this person is your emergency contact.
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Mother/Guardian given name(s) Country of birth

Country

Roosevelt University International Study Center, 18 S. Michigan Avenue, Gage 211, Chicago, IL 60603, USA rooseveltiscadmissions@studygroup.com isc.roosevelt.edu Admissions Direct Telephone: 312-282-3163

Approved Recruitment Partner

Name Agency name or company Email URN
For administration purposes only

Agent stamp here

Dependents
Information on spouse and children accompanying student to USA as of the date students will begin classes at the ISC (if applicable) Name City of birth Citizenship (if different from place of birth) Name City of birth Citizenship (if different from place of birth) Name City of birth Citizenship (if different from place of birth) Name City of birth Citizenship (if different from place of birth) Date of birth (dd/mm/yyyy) Country of birth Relationship to student Date of birth (dd/mm/yyyy) Country of birth Relationship to student Date of birth (dd/mm/yyyy) Country of birth Relationship to student Date of birth (dd/mm/yyyy) Country of birth Relationship to student Gender: M F Gender: M F Gender: M F Gender: M F

Undergraduate applicants - High School Education

Please list the details of the school you will/have graduated from. Undergraduate applicants please send official secondary school transcript for final 3 or 4 years. Name of school Start date School address City State/Province Zip/Postal code Country Graduation date Average grades/Results/GPA

Roosevelt University International Study Center, 18 S. Michigan Avenue, Gage 211, Chicago, IL 60603, USA rooseveltiscadmissions@studygroup.com isc.roosevelt.edu Admissions Direct Telephone: 312-282-3163

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Previous education College/University education

Please list the names and dates of each college/university you attended, if any. Pre-Masters applicants - please provide entire undergraduate transcript. Name of College/University Start date Average grades/Results/GPA* School address City State/Province Zip/Postal code Country Graduation date Subject/major Name of degree awarded

Name of College/University Start date Average grades/Results/GPA* School address City State/Province Zip/Postal code Country Graduation date Subject/major Name of degree awarded

Name of College/University Start date Average grades/Results/GPA* School address City State/Province Zip/Postal code Country Graduation date Subject/major Name of degree awarded

Name of College/University Start date Average grades/Results/GPA* School address City State/Province Zip/Postal code Country Graduation date Subject/major Name of degree awarded

Standardized Testing
Please enclose copies of your test score reports*, if any. TOEFL: Date taken (dd/mm/yyyy) IELTS: Date taken (dd/mm/yyyy) Password language test: Date taken (dd/mm/yyyy) SAT/ACT Test: Date taken (dd/mm/yyyy) Other Test: Date taken (dd/mm/yyyy) Name of other test * Certified original copies of all transcripts and score reports will be required upon registration. Score Score Knowledge score Writing score Score Score

Roosevelt University International Study Center, 18 S. Michigan Avenue, Gage 211, Chicago, IL 60603, USA rooseveltiscadmissions@studygroup.com isc.roosevelt.edu Admissions Direct Telephone: 312-282-3163

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Criminal and Disciplinary Record

Other than traffic violations, have you ever been convicted of a misdemeanor, felony or other crime? Yes No No Have you ever been charged, suspended, removed, dismissed or expelled from any educational institution for academic or disciplinary reasons? Yes

If you answered yes to either of the above, submit a full statement of relevant facts (including approximate date of the incident/s) on a separate sheet of paper, marked with your name.

Passport Details
Passport number Name as shown on passport Country of issuance Expiration date (dd/mm/yyyy)

Sponsor/Fee Payer
 Please check this box if the sponsor/fee payer contact details are the same as the parent/guardian details on page 2. Check this box if the student will be responsible for paying their own fees. If the sponsor/fee payer contact details are not the same as the parent/guardian details above, please give details of the person/organization responsible for payment of fees. Sponsor/Fee payer organization Sponsor/Fee payer family name(s) Sponsor/Fee payer given name(s) Relationship to student Address City Home telephone number Email State/Province Zip/Postal code Mobile/Cell phone number Country Date of birth (dd/mm/yyyy) Country of birth First language Age Gender: M F

Payment Details
Bank name BANK OF AMERICA Account name STUDY GROUP ABA routing 0260-0959-3 Bank address 1185 AVENUE OF THE AMERICAS City NEW YORK State/Province NY Zip/Postal code 10036 Country USA Account number 9417-201482 Swift code BOFAUS3N

How did you hear about us?

Choose one of the following: Agent Educational fair Friend/relative recommendation

Please specify the name if recommendation came from a current or previous ISC student Other (please specify)

Roosevelt University International Study Center, 18 S. Michigan Avenue, Gage 211, Chicago, IL 60603, USA rooseveltiscadmissions@studygroup.com isc.roosevelt.edu Admissions Direct Telephone: 312-282-3163

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Declaration
Agreement by the student (if over 18), parent, legal guardian or sponsor.
If the student is under 18, this must be signed by the parent or legal guardian. I apply to enroll the person named as a student of Study Group USA Higher Education LLC. I agree to pay all fees incurred by the student as they become due, and either give the required notice of cancellation or to pay the required fees in lieu of notice. I agree to abide by the terms and conditions of Study Group USA Higher Education LLC. I give permission for the administration of first aid and appropriate non-prescription medication to my child, and give permission to Study Group USA Higher Education LLC and designated representatives to seek medical, dental or optical treatment when required. I am the parent or legal guardian named. We, as parents/guardians of the undersigned student, do hereby authorize Study Group USA Higher Education LLC and its assigned agents, and any designated program representative, as agents of the undersigned parents, to consent to any x-ray examinations, anesthetic, medical or surgical diagnosis or treatment, or hospital care which is deemed advisable by, and is rendered under, the general supervision of any licensed physician or surgeon, whether such treatment or diagnosis is rendered at the office of said physician or surgeon or at a hospital. It is understood that this authorization is not given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of aforesaid agents to give specific consent to any and all such diagnoses, treatments, or hospital care which the aforementioned physician or surgeon, in the exercise of her/his best judgment, may deem advisable. We, the undersigned, agree that the students images and sound, details and achievements may be used in any media for promotional purposes without written consent or notification. This includes permission to pass them on to third parties (agents, publications, etc) at our discretion as long as the images are used to publicize study group programs. We, the undersigned, waive and release all claims against Study Group USA Higher Education LLC and its agents for any injury, loss, damage, accident, delay or expense resulting from the applicants participation in the program. We also release Study Group USA Higher Education LLC and its agents and agree to indemnify them with regard to any financial obligations or liabilities that the applicant may personally incur or any damage or injury to the person or property of others that the applicant may cause while participating in this program. We understand that the program begins with the outbound flight to the united states and terminates when the return flight lands. We realize that any airlines liability for loss or damage to baggage or property, or for death or injury, is limited by the terms outlined by the airlines. We also understand that it is our responsibility to obtain a passport and any required visa. We understand that Study Group USA Higher Education LLC is not responsible for any loss or injury suffered by the applicant at any time while participating in the program, including but not limited to losses or injury suffered during periods of independent travel or absence from the program. If the applicant becomes ill or incapacitated, Study Group USA Higher Education LLC or its agents may take such action as it considers necessary, including securing medical treatment and transporting the applicant home at his/her own expense. We release Study Group USA Higher Education LLC from all liability related to such actions. We understand that the applicants participation in the program may be terminated at the discretion of Study Group USA Higher Education LLC without any refund of fees and that the applicant may be sent home at his/her own expense if he/she does not adhere to the U.S., State, and local laws and college/university rules. We agree to accept full responsibility for personal expenses, books, any required additional language training and round trip air fare. In the event that Study Group USA Higher Education LLC or its agents advances or loans any funds to the applicant or incurs special expenses on his/her behalf, we agree to make immediate repayment to Study Group USA Higher Education LLC. We understand that this agreement cannot be modified except in a writing signed by Study Group USA Higher Education LLC. Full name (student) Signed Date

Name of Parent/Legal guardian (if applicant is under 18) Signed Date

Name of Financial sponsor (if your financial sponsor is different to your parent/legal guardian) Signed Date

Roosevelt University International Study Center, 18 S. Michigan Avenue, Gage 211, Chicago, IL 60603, USA rooseveltiscadmissions@studygroup.com isc.roosevelt.edu Admissions Direct Telephone: 312-282-3163

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Terms and Conditions

Participant responsibility
The price for the Study Group USA Higher Education LLC invoiced program does not encompass additional ancillary expenses, including but not limited to: 1) Personal spending money. 2)  Insurance for pre-existing medical conditions, i.e., ailments which exist prior to arrival in the U.S. 3)  Meal and housing costs during the few times the university is officially closed usually limited to the Thanksgiving holiday in late November, the Christmas holiday (which normally lasts about four weeks) and Spring vacation (approximately 10 days). 4)  University textbooks and other necessary school supplies. 5)  Air fare to and from U.S. domestic airport closest to the university campus in the United States (a round trip ticket is required). 6)  Extra costs for ESL which may be required by a student whose English language proficiency is inadequate. 7)  Graduate student housing varies per university. Please refer to the school-specific Study Group website for further details.

Length of enrollment

1)  First year undergraduate and EAP students must enroll for an entire academic year (2 semesters) and may be required to live on the university campus or in university-approved housing. 2)  Returning undergraduate students will be re-enrolled for an entire academic year and may live off campus if university policy permits. 3)  Graduate students must enroll in their complete academic program. Upon arrival, students will be given a placement examination to assess their English language level. Many institutions also require an assessment in Math. As a result, the length of study may be longer than originally anticipated, incurring extra costs for which the student will be responsible.

Publicity

Students (and their parents or guardians, where applicable) agree that their images and sound, details and achievements may be used in any media for promotional purposes without written consent or notification. This includes permission to pass them on to third parties (agents, publications, etc.) at our discretion as long as the images are used to publicize Study Group programs.

We understand that the applicants participation in the program may be terminated at the discretion of Study Group USA Higher Education LLC without any refund of fees and that the applicant may be sent home at his/her expense if he/she does not adhere to the U.S., State, and local laws and college/ university rules. We agree to accept full responsibility for personal expenses, books, any required additional language training and round trip air fare. In the event that Study Group USA Higher Education LLC or its agents advances or loans any funds to the applicant or incurs special expenses on his/her behalf, we agree to make immediate repayment to Study Group USA Higher Education LLC. We understand that thisAgreement cannot be modified except in a writing signed by Study Group USA Higher Education LLC.

Data protection

Study plan changes

Progression

Rules

Progression at the end of any given semester is dependent on successfully passing all courses in that semester and necessary progression requirements. Partner institutions may have additional requirements for progression. These additional requirements will be reviewed during orientation. Undergraduate students are conditionally accepted to a college or university, not necessarily into a particular program of study. Institutions reserve the right to impose additional academic requirements post arrival (such as minimum grade point average) before a student is formally admitted into a particular program of study.

All participants in the Study Group USA Higher Education LLC program are subject to the rules of the university in which they are enrolled. Students must assume full responsibility for compliance. Students must adhere to all housing regulations of the university, to include payment, withdrawal, and cancellation. Rules governing alcohol, tobacco, controlled drugs and other serious offenses will be strictly enforced. Applicants are reminded that international students in the United States must comply with both the letter and the spirit of the law in order to retain valid student visas. Violations of such laws will render the participant liable for immediate dismissal from the program and repatriation to the home country, if not legal prosecution for violation of the laws of the state or federal jurisdictions involved. No refund of fees will be made in the event of dismissal or withdrawal. Students seeking transfer between the date of initial arrival in the United States and the first day of classes may have their I-20 cancelled by the institution to which they were accepted, and no refunds will be granted Admission is subject to availability. Early application and payment is advised.

Any information provided to Study Group USA Higher Education LLC may be held on computer and shall be used in accordance with US law, including FERPA, HIPAA, and ADA. Study Group USA Higher Education LLC is an Equal Opportunities provider. Information provided to Study Group USA Higher Education LLC is held and processed for the purpose of administering your application, and may be carried forward to your official student record, which holds data in electronic and paper form on your personal details, academic and administrative history and on relevant financial transactions. After you leave, the parts of your student record which the college or university needs to retain will be archived. Some information will also be processed for the purpose of managing our relationship with you as an alumnus. Other information will be destroyed. Throughout, your personal data will be held in accordance with current US data protection law.

Applying for a visa

Once a student has been accepted, s/he will be provided with an I-20 from the United States Citizenship and Immigration Services (USCIS), issued by the participating college or university. This form will be sent upon receipt of deposit. An I-20 is required to start the process of obtaining a student visa to enter the United States. You will also be required to present financial documentation to the United States Citizenship and Immigration Services (USCIS) consular office in your country. We advise you to have a letter from your parents/guardian, financial sponsor or other source of support stating their responsibility for your expenses throughout. A bank statement or letter verifying their financial ability to cover your expenses should also be provided. The bank statement cannot be a copy; it must be original (per immigration law). The bank statement must be notarized and no older than six months. Also, in addition to the bank statement, we require an affidavit of support, which is an original letter from the students sponsor (such as parent or guardian), claiming financial responsibility for the student. This affidavit must also be notarized. If the student is self-sponsored, no affidavit is required. In the case of SACM students, the Financial Guarantee serves as both the bank statement and the affidavit. We recommend that all students apply for their visa as soon as possible, and notify Study Group USA Higher Education LLC directly once your visa status is known. Please notify your academic enrolment advisor when you have made an appointment, and notify your counselor with the outcome of that appointment.

Variation

Insurance

All students are required to be properly insured. StudyCare insurance will be automatically added to your booking, unless proof of comparable insurance is provided upon application. Please note that StudyCare includes services beyond typical health insurance policies in the United States, e.g. cancellation, emergency repatriation, personal liability etc. US-based health insurance is mandatory for all students. Insurance policies based in countries outside of the United States will not be accepted as reasonable substitutes. While Study Group provides StudyCare Insurance, some Institutions will require students to have a student health insurance policy directly from the institution instead. Insurance coverage begins upon arrival and insurance cards are issued post arrival on campus.

No variation to these conditions is valid unless agreed in writing by the Center Director and approved by the Managing Director, North America provided always that the Study Group USA Higher Education LLC reserves the right to make any addition, amendment or alteration to these conditions upon giving one semesters written notice of such change to all affected students.

Communication

Please supply Study Group USA Higher Education LLC with personal e-mail addresses and mobile/cell numbers prior to arrival, in order that communication, to include transmission of student reports, may be maintained at all times. Please also advise of any changes as they occur.

Agreement and release

Payment Policy:

Students are required to pay a deposit directly to Study Group USA Higher Education LLC before they receive an I-20 form from the partner institution. Deposit amounts vary. Payment for the Fall semester is due July 1st. Payment for the Spring semester is due November 1st. Payment for the Summer semester is due April 1st. All students are required to pay the entire invoiced amount in full and in advance of the semester start date. Students may pay by semester or for the full year. Students accepted by an institution after the billing due date are required to pay their deposit immediately upon receipt of an acceptance letter, and are required to pay their bill in full prior to their departure for the United States, or within thirty days of deposit, whichever comes first. Students will not receive their pre-arrival information until full payment is received. Students with outstanding balances will be immediately placed on hold by the host institution, and may be barred from attending classes until payment is made in full. Payments by credit card after the due date will be subject to a fee of 2% of the total invoiced amount. Students with balances due after 30 days are subject to a $500 late payment fee. Wire payments are recommended. Please refer to the following Bank Details in order to make a wire transfer.

Damage and liability

Any reference in these terms to liability of students shall also infer liability on the parent or financial sponsor, and such liability is joint and several. Students are responsible for payment for any damage caused by them to Study Group USA Higher Education LLC/institution property, including fixtures and fittings in college or university-approved accommodation. Occupants of shared accommodation are jointly and severally liable for the proper care of rooms, fixtures and fittings and the university reserves the right to recover costs for damage or exceptional cleaning. Withdrawal/variation of degree programs If, after a Study Group USA Higher Education LLC applicant has indicated an intention to progress onto a particular degree program, but prior to the student completing the Study Group USA Higher Education LLC program, the college or university discontinues the nominated degree program, the student may either: (1) withdraw without liability for fees other than the fee liability for the Study Group USA Higher Education LLC program, or (2) transfer to such other program (if any) as may be offered by the college or university for which the student is qualified. If in these circumstances the student wishes to withdraw from the college or university and to enroll in a course at a different institution, the college or university shall use its reasonable endeavors to assist the student. Once the student has commenced the first semester of their college or university program, if: (a) the college or universitys ability to deliver programs or other services in accordance with the descriptions provided is compromised by circumstances beyond the control of the college or university (e.g. third party industrial action), the college or university will use all reasonable endeavors to minimize disruption as far as it is practical to do so; (b) the Program is cancelled or substantially varied from that described in the prospectus for reasons other than circumstances beyond the institutions reasonable control, the college or university will use reasonable endeavors to provide a suitable replacement program, but cannot guarantee to do so. If the student does not wish to accept the replacement program, the student shall be entitled to withdraw from the program. In the event of such withdrawal the college or university shall make an appropriate refund of tuition fees. Depending on the point at which the withdrawal takes place, the college or university reserves the right to retain fees or charges to cover the tuition, housing, or services which the student has actually received.

I apply to enroll the person named as a student of Study Group USA Higher Education LLC. I agree to pay all fees incurred by the student as they become due, and either give the required notice of cancellation or to pay the required fees in lieu of notice. I agree to abide by the terms and conditions of Study Group USA Higher Education LLC. I give permission for the administration of first aid and appropriate non-prescription medication to my child, and give permission to Study Group USA Higher Education LLC and designated representatives to seek medical, dental or optical treatment when required. I am the parent or legal guardian named. We do hereby authorize Study Group USA Higher Education LLC and its assigned agents, and any designated program representative, as agents of the undersigned parents, to consent to any x-ray examinations, anesthetic, medical or surgical diagnosis or treatment, or hospital care which is deemed advisable by, and is rendered under, the general supervision of any licensed physician or surgeon, whether such treatment or diagnosis is rendered at the office of said physician or surgeon or at a hospital. It is understood that this authorization is not given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of aforesaid agents to give specific consent to any and all such diagnoses, treatments, or hospital care which the aforementioned physician or surgeon, in the exercise of her/his best judgment, may deem advisable. We waive and release all claims against Study Group USA Higher Education LLC and its agents for any injury, loss, damage, accident, delay or expense resulting from the applicants participation in the program. We also release Study Group USA Higher Education LLC and its agents and agree to indemnify them with regard to any financial obligations or liabilities that the applicant may personally incur or any damage or injury to the person or property of others that the applicant may cause while participating in this program. We understand that the program begins with the outbound flight to the United States and terminates when the return flight lands. We realize that any airlines liability for loss or damage to baggage or property, or for death or injury, is limited by the terms outlined by the airlines. We also understand that it is our responsibility to obtain a passport and any required visa. We understand that Study Group USA Higher Education LLC is not responsible for any loss or injury suffered by the applicant at any time while participating in the program, including but not limited to losses or injury suffered during periods of independent travel or absence from the program. If the applicant becomes ill or incapacitated, Study Group USA Higher Education LLC or its agents may take such action as it considers necessary, including securing medical treatment and transporting the applicant home at his/her own expense. We release Study Group USA Higher Education LLC from all liability related to such actions.

Cancellation policy

Cancellation policy varies and is subject to the partner institutions policy. A semesters notice will be required to terminate any program of study, or fees in lieu of notice will be charged.

Bank Details

IMPORTANT: When wiring monies, include the student name on the account. If no student name is linked to the wire, delays with processing the payment will likely occur. Bank name Bank Of America Account number 9417-201482 ABA routing 0260-0959-3 Swift code BOFAUS3N Bank address 1185 Avenue of the Americas New York 10036 USA

Roosevelt University International Study Center, 18 S. Michigan Avenue, Gage 211, Chicago, IL 60603, USA rooseveltiscadmissions@studygroup.com isc.roosevelt.edu Admissions Direct Telephone: 312-282-3163

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