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Educational Background Survey Fillable

This document is an international student educational background survey from Northwestern State University of Louisiana. It requests information from international students such as name, country of birth, citizenship, permanent residence, native language, and a list of previous education from primary school through college. It also asks if a student has ever attended another college or university previously. Additional questions inquire about a student's current visa status, dates of entry to the US, and previous schools attended with I-20 or DS-2019 forms. It requests information on credit hours completed and GPA if a student is currently attending another US school. The student must certify the accuracy of the information provided and sign and date the form.

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Olawale Dawodu
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46 views1 page

Educational Background Survey Fillable

This document is an international student educational background survey from Northwestern State University of Louisiana. It requests information from international students such as name, country of birth, citizenship, permanent residence, native language, and a list of previous education from primary school through college. It also asks if a student has ever attended another college or university previously. Additional questions inquire about a student's current visa status, dates of entry to the US, and previous schools attended with I-20 or DS-2019 forms. It requests information on credit hours completed and GPA if a student is currently attending another US school. The student must certify the accuracy of the information provided and sign and date the form.

Uploaded by

Olawale Dawodu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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NORTHWESTERN STATE UNIVERSITY OF LOUISIANA

International Student Resource Center


INTERNATIONAL STUDENT EDUCATIONAL BACKGROUND SURVEY
Complete this form and return to: [email protected]

Name:
Last First Middle
Address:

Country of Birth: City of Birth: Country of Citizenship:

Country of Legal Permanent Residence: Native Language:

List all years of previous education from primary to college/university. (Attach additional pages if necessary.)
Please be advised if you have ever attended another college or university, either while in high school or after graduation from
high school - you are required to disclose this information to NSU. Failure to disclose past attendance at any post-secondary
institution can result in denial of admission and student disciplinary actions

Calendar Year in Kind of School Name of Certification or


Year School Primary/Secondary/ School Degrees Received
College

1. If you are currently in the U.S., give date of entry:

2. What type of VISA did you hold at entry? What type of VISA do you hold now?

3. Date your status changed (if applicable)

4. If you already have an F-1/J-1VISA, what institution issued the I-20/DS-2019 to you?

Have you attended that institution?  Yes  No If no, why?


Will you request your current I-20/DS-2019 to be transferred to NSU?  Yes  No
If no, why?
5. If you are currently in the US attending another US college/university:
o How many credits have you completed?
o What is your GPA (Grade Point Average)?
6. What Institution were you last authorized to attend?

7. Have you participated in OPT?  Yes  No If so, please list dates of employment and employer name:

8. Have you participated in CPT?  Yes  No If yes, please list dates of employment:
 Full-time  Part-time (Please mark one)

Please Note: International Students should attend the Institutions that issued them the I-20 for at least one semester before transferring to
another Institution.

I certify that the above statement regarding my education is correct and will be substantiated by certificates or transcripts.

Signature Date

A member of the University of Louisiana System


nsula.edu @nsula Facebook.com/Northwestern State revised: 9/16/2021

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