Keiser University International Centers Application

Please Fill Out the Application Below

Name(Required)

Given/First Family/Surname

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Date of Birth(Required)

Place of Birth

City/State/Country

Which International Center of Keiser University Will You Attend?(Required)

Student Number (if you previously attended Keiser University)

Name(s) of Planned Program/Degree(Required)

Name(s) of Planned Concentration(s):

Name of College Entrance Exam Taken

Month/Year of the Exam

Score

Language Proficiency Test Taken

Month/Year of the Exam

Score

Please List All High School, Colleges/Universities You are Currently Attending or in Which You Have Been Enrolled(Required)

Institution

City/State/Country

Field of Study

Dates (mm/yy to mm/yy)

Degree(s) Earned

GPA

Please Click the + to Add Additional Rows

Professional or Work Experience

Dates (mm/yy to mm/yy)

Employer

Location

Title/Position(s)

Please Click the + to Add Additional Rows

Academic honors, prizes or scholarships you have received or honor societies to which you have been elected:

Professional organizations in which you currently hold membership(s):

Title or description of any thesis, research report, patent or other publications:

Please describe your background (e.g., coursework, professional and research experience, etc.) as it pertains to your area(s) of interest at Keiser University:

Signature

Please type in your name.

Current Date(Required)

Certification/Agreement(Required)

By checking this box, I certify that my typed in name above serves as my signature. I also certify that the statements made in this application are true to the best of my knowledge. If admitted, I agree to abide by the rules and regulations of Keiser University.

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Keiser University International Center Application

Please Fill Out the Application Below