OFFICE OF INTERNATIONAL.docVIP

OFFICE OF INTERNATIONAL PROGRAMS AND STUDIES (OIPS) MSC06 3850 1 University of New Mexico Albuquerque, NM 87131-1056 Phone (505) 277-4032 ( Fax (505) 277-1867 Email oips@ Web: /oips INTERNATIONAL STUDENT EXCHANGE PROGRAM APPLICATION PLEASE ATTACH A COPY OF THE BIOGRAPHICAL PAGE OF YOUR PASSPORT SEMESTER TO WHICH YOU ARE APPLYING: FALL (AUGUST) ONLY______ OR SPRING (JANUARY) ONLY ______ OR BOTH, SPRING AND FALL ________ OR BOTH, FALL AND SPRING ________ PROPOSED AREA/SUBJECT OF STUDY AT THE UNIVERSITY OF NEW MEXICO: _____________________________________________________________________________ 1. NAME:_____________________________________________________________________ LAST OR FAMILY / FIRST OR GIVEN / MIDDLE -AS IT APPEARS ON YOUR PASSPORT- 2. OTHER NAME (S): __________________________________________________________ AS THEY APPEAR ON EDUCATIONAL RECORDS 3. DATE OF BIRTH: _______________________ 5. GENDER: FEMALE MALE MONTH/DAY/YEAR 4. PLACE OF BIRTH:___________________________________________________________ CITY AND COUNTRY 5. ETHNIC/BACKGROUND INFORMATION: (The University of New Mexico is required by Federal law to request this information. Your response is voluntary) INDIAN AMERICAN BLACK NON-HISPANIC HISPANIC WHITE NON-HISPANIC ASIAN PACIFIC ISLANDER OTHER: _________________________ PLEASE INDICATE 6. COUNTRY OF CITIZENSHIP: ________________________________________________ 7. COUNTRY OF LEGAL PERMANENT RESIDENCE: _____________________________ 8. ADDRESS: _________________________________________________________________ STREET/APARTMENT OR HOUSE NUMBER/CITY/ POSTAL CODE/COUNTRY 9. PHONE NUMBER: ________________________________________________________ COUNTRY CODE/AREA CODE/ PHONE NUMBER 11. EMAIL ADDRESS: _________________________________________________________ 12. ARE YOU CURRENTLY IN THE US: YES NO IF YES, WHAT IS YOUR IMMIGRATION STATUS? F1