*****========= ## ## ## ## ##### *****========= ###### ## ## ###### ## ## *****========= ## ## ## ## ## ## ##### ============== ###### ###### ###### ## STUDY IN THE ============== ## ## ###### ## ## ## U S A AUAP AMERICAN UNIVERSITIES ADMISSION PROGRAM AUAP Registration Form - Questionnaire (This document is best viewed in a non proportional font like Courier) C O N G R A T U L A T I O N S !!! + You are mastering your future by entering into an American university. We will help you to select the five best universities for you according to your qualifications and tastes. + Please reply as soon as possible as it will enhance your chance of being admitted. + Be frank and express about yourself; this choice is crucial for your future and career. You may skip questions. + If you need more room to answer a question, you may continue on a separate paper. + All information provided will be kept confidential by American Universities Admission Program and will be used only for purposes of rendering the services requested. ****************************************************************************** INSTRUCTIONS + Please mark with an X where applicable or fill where the lines are. + If you need more space feel free to continue on a separate piece of paper. + Send filled in form by fax or mail to AUAP. [ AUAP American Universities Admission Program ] [ 5053 Ocean Blvd., Suite 19 - Sarasota FL 34242 -USA ] [ Fax (1) 941 349 43 70 ] ****************************************************************************** PLEASE TELL US ABOUT YOURSELF Preferred Entry Session: ________________________________________ Last Name: __________________________________________________ First Name: __________________________________________________ Date of Birth: (dd/mm/yyyy) _____________________________________ Nationality: __________________________________________________ Gender: [__] Female / [__] Male Address: __________________________________________________ City: __________________________________________________ Postal code: __________________________________________________ Country: __________________________________________________ Phone: __________________________________________________ Fax: __________________________________________________ E-Mail: __________________________________________________ ****************************************************************************** Current School or University: __________________________________________ Current year of study: __________________________________________ School/University Name and Address: __________________________________________ School/University telephone: __________________________________________ School/University Fax: __________________________________________ High School Students specify the curriculum you are following University Students list the courses you are taking (This year) __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ ****************************************************************************** Father's name and occupation: ________________________________________________ Diploma,University: ________________________________________________ Mother's name and occupation: ________________________________________________ Diploma,University: ________________________________________________ Age and name of the other children in your family __________________________________________________ __________________________________________________ ****************************************************************************** Have you had contact with any graduate of an American college or university? [__] Yes / [__] No If yes, give us his/her name and address: __________________________________________________ __________________________________________________ For Foreign Students: Are there any American citizens in your family? [__] Yes / [__] No If yes, give us his/her name and address: __________________________________________________ __________________________________________________ ****************************************************************************** How did you learn about AUAP?: __________________________________________________ __________________________________________________ Name of AUAP Representative(s) who have contacted you: __________________________________________________ __________________________________________________ ****************************************************************************** ADDITIONAL COMMENTS: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ****************************************************************************** YOUR PERSONAL PREFERENCES Please mark with Unacceptable, Acceptable or Desirable what best expresses your taste. You may skip questions if desired. I. University / College Type Undergraduate .......................................... [__] Acceptable (after secondary school) Graduate School ........................................ [__] Acceptable Masters degree Graduate School ........................................ [__] Acceptable Doctorate or Terminal degree (Ph.D., Ed.D., Psy.D.) Unacceptable Acceptable Desirable Public .................... [__] [__] [__] Private ................... [__] [__] [__] (Harvard, MIT, etc.) Religious ................. [__] [__] [__] Coeducation ............... [__] [__] [__] (both sexes) Single Sex................. [__] [__] [__] (Please mark with an X where applicable) ****************************************************************************** II. University Environment Unacceptable Acceptable Desirable A. Urban (large metropolitan area)........ [__] [__] [__] B. City .................................. [__] [__] [__] C. Suburban (close to a city) ............ [__] [__] [__] D. Rural (small town or far from a city) . [__] [__] [__] [Please mark with an X where applicable] ****************************************************************************** III. University Size Unacceptable Acceptable Desirable A. Small (less than 1,500 students) ...... [__] [__] [__] B. Mid size (1,501 - 4,000) .............. [__] [__] [__] C. Large (4,001 - 10,000) ................ [__] [__] [__] D. Very large (10,000+) .................. [__] [__] [__] [Please mark with an X where applicable] ****************************************************************************** IV. University Lodging Unacceptable Acceptable Desirable A. On campus ............................. [__] [__] [__] B. Apartment, etc. off campus ............ [__] [__] [__] [Please mark with an X where applicable] ****************************************************************************** V. Yearly Budget Include all costs - tuition, meals, lodging and all mandatory fees. Financial aid is sometimes available for international students. Indicate the maximum yearly amount available from your family. [__] A. Less than $10,000/year [__] B. $10,001 - $15,000 [__] C. $15,001 - $20,000 [__] D. $20,001+ [Please mark with an X where applicable] Total income of your parents last year: __________________________________________________ __________________________________________________ ****************************************************************************** VI. Preferred Location Unacceptable Acceptable Desirable A. New England (Northeast) .... [__] [__] [__] B. Atlantic States ............ [__] [__] [__] C. South ...................... [__] [__] [__] D. West ....................... [__] [__] [__] E. Northwest .................. [__] [__] [__] F. Midwest .................... [__] [__] [__] [Please mark with an X where applicable] ****************************************************************************** VII. Religious affinity (if important) Religion __________________________________________________ __________________________________________________ I would like to be with students sharing the same religion: [__] Yes / [__] No / [__] No Preference [Please mark with an X where applicable] ****************************************************************************** VIII. Sports Here is a list of sports common at American universities. Tell us which ones you already participate in at the competition or leisure level [__] American Football [__] Field Hockey [__] Softball [__] Archery [__] Golf [__] Squash [__] Badminton [__] Gymnastics [__] Swimming and Diving [__] Baseball [__] Ice Hockey [__] Table Tennis [__] Basketball [__] Lacrosse [__] Tennis [__] Bowling [__] Riflery [__] Track and Field [__] Crew [__] Rugby [__] Volleyball [__] Cross Country Running [__] Sailing [__] Water Polo [__] Equestrian [__] Skiing [__] Weight Lifting [__] Fencing [__] Soccer [__] Wrestling [Please mark with an X where applicable] I compete in the following sport: __________________________________________________ __________________________________________________ (Specify the level as it may be important for undergraduate scholarship possibilities) I would like to practice the following sport for my leisure: __________________________________________________ __________________________________________________ ****************************************************************************** IX. Activities American universities have abundant cultural and associative activities. Please indicate your preference. [__] Choral [__] Orchestra [__] Dance [__] Political groups [__] Debate [__] Radio / TV [__] Drama [__] Religion [__] Fraternities [__] Service clubs [__] Honor societies [__] Student Govt. [__] Magazine [__] Yearbook [__] Newspaper [Please mark with an X where applicable] I would like to participate in the following activities: __________________________________________________ __________________________________________________ ****************************************************************************** X. Future Career Indicate your career goals in order of preference: 1. __________________________________________________ 2. __________________________________________________ 3. __________________________________________________ ****************************************************************************** XI. Favored Majors or Graduate Degree Degrees: 1. __________________________________________________ 2. __________________________________________________ ****************************************************************************** XII. Favored University Please let us know if you already have a university in mind. (We will advise you if it is suitable) Name of University: __________________________________________________ __________________________________________________ ****************************************************************************** XIII. Extracurricular activities or work experience (that is relevant to your application) Please list your activities such as sports, community or civic involvement, art, leadership, elective post, clubs or societies. Also list all honors and diplomas you have received. Experience: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ ****************************************************************************** XIV. Personal Essay (Optional) Write a brief essay about who you are, your personality and your career goals. This helps us to assess the best choices. You may attach it on a separate piece of paper. Essay: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ****************************************************************************** XV. Tests Various tests are required as part of the admissions process to American universities. Have you taken, or are you registered to take, any American tests (i.e., TOEFL, SAT, SMAT, GRE, etc.)? If so, please list the test, test date and scores. Tests: __________________________________________________ __________________________________________________ __________________________________________________ ****************************************************************************** XVI. Referral Please send us the names and addresses of three persons who may be interested in the services of AUAP. Thank you! Referrals: 1. __________________________________________________ 2. __________________________________________________ 3. __________________________________________________ ****************************************************************************** XVII. Academic Profile In order to match you to the best universities, we need to understand your academic performance. Please write about your transcripts/exam results and subjects or send us a copy my normal mail/post or write this out on a separate piece of paper. (All American universities will require official transcripts at time of application.) Please include subjects, rank in class, grades, specializations, etc. ****************************************************************************** SUBSCRIPTION Yes, I want to subscribe to the following program(s): [__] SELECTION PROGRAM $350 for 4 universities [__] GUARANTEED ADMISSION PROGRAM ннннн(Does not include tests & application fees) ннннн$1650 for 4 universities [__] FULL SERVICE GUARANTEED ADMISSION PROGRAM $2000 for 4 universities [__] ENGLISH LANGUAGE PROGRAM $350 ADMISSION PROGRAM ADD-ONS [__] ADDITIONAL UNIVERSITY $300 USD per university [__] RUSH SERVICE $100 USD per university [__] CONTINUING SUPPORT $100 USD per hour [Please mark with an X where applicable] ****************************************************************************** PAYMENT Amount: __________ US $ [__] Credit Card VISA - MasterCard / EuroCard American Express For credit card payment: ______________________________________ Card holder: ______________________________________ Card number: ______________________________________ Expires: _______________________ (Month / Year) [__] Travellers Cheques in US Dollars [__] Bank Draft in US Dollars Payable to American Universities Admission Program (AUAP) [__] Wire Transfer Contact AUAP for wiring information [Please mark with an X where applicable] ****************************************************************************** ****************************************************************************** AUAP American Universities Admission Program 5053 Ocean Blvd., Suite 19 - Sarasota FL 34242 -USA Tel: (1) 941 346 1427 - Fax (1) 941 349 43 70 - e-mail: auap@auap.com http://www.auap.com ****************************************************************************** ****************************************************************************** _ (c) 1999 American Universities Admission Program Created 1999 by Ramon Bartschat