Mr. Ms. Last Name (Legal family name) First Name & Middle Initial

Birthdate: day month year Birthplace (Country)

Nationality(ies) - please attach photocopy of passport

Native language(s) Other languages spoken

Street Address

City, State, Postal Code

Country

Mobile Telephone (include country code)

E-mail address

Year:

English as a Second Language Program (ESL)

Application for Admission

Stud

ent's

Cur

rent

Add

ress

Educ

atio

n

Passport Photograph (please click box to insert

photo)

This is a "form-fill" PDF. You may type directly into the form from your computer.

(as they appear on official documents)

(in order of fluency, from most fluent to least fluent) - please indicate number of years studied

Birthplace (City)

Higher Diploma

Current University / School

Current Degree

City

Country

Decision q Admitted

q Not admitted

Reserved for IUM Admissions

Date Received ______________________________

Decision Date ______________________________

Cambridge Certificate of Proficiency

English Level

Test Date Total Score

TOEFL (original score report less than 2 years old) ___________________

TOEIC (original score report less than 2 years old)

___________________

___________________Cambridge CAE

___________________IELTS

___________________

___________________

___________________

___________________

Referral - IUM Alumni (specify name)

How did you first hear about IUM?

Other (specify) or unknown

Referral - IUM Current Student (specify name)

Referral - IUM Faculty or Staff (specify name)

Graduate recruitment fair or conference (specify name)

Referral - Friend or Relative (specify name)

Print - Guides & Catalog Listings (specify)

Print - Rankings (specify)

Print - Press & Articles (specify)

Print - Ads (specify)

School Visit

Web Search & Internet Listing (specify)

Please indicate if you have already taken an English proficiency test:

Other: _________________________________________________________________________________________________

___________________ ___________________

By signing below, I certify that the information I have provided in my application file is complete and correct to the best of my knowledge.

Date: _______________________________ Name: __________________________________ Signature:___________________________________________

Send the completed application by mail along with two passport style photos to the University address below International University of Monaco Admissions Office

2, avenue Albert II, MC 98000 Principality of MonacoTelephone: + 377 97 986 986, Fax: + 377 97 986 999, E-mail: admissions@monaco.edu, Website: www.monaco.edu

Application ChecklistCompleted application form

Copy of your English proficiency test results if applicable 2 passport style and size photographs

Pq

q q

Photocopy of your passport or ID cardq

Payment must be made in euros, by transfer, by credit card or cash (payment on site only). Applicants should include their name on the transfer order if they are not the account holder, and always enclose a copy of their transfer. Send the completed application by mail along with two passport style photos to the University address below.

Payment by wire transfer: Account name: IUM - International University of Monaco Address of account holder: 2, avenue Albert II - MC 98000 Monte-Carlo, Principality of Monaco Bank name: Société Générale Monaco Fontvieille Bank address: 11, avenue des Papalins - MC 98000 MONACO - Bank code: 30003 Agency code: 00952 Account number: 00020081646 Key: 41 International identification (IBAN) MC76 30003 00952 00020081646 41 SWIFT address: SOGEFRPP

Payment

The International University of Monaco does not discriminate on the basis of race, color, national origin, religion, sex, physical or mental disability, medical condition, ancestry, marital status, age, sexual orientation or citizenship in any of its policies, procedures or practices. This nondiscrimination policy covers admission and access to treatment and employment in the University's programs and activities.

Please indicate how many years you have studied English for: _____________ years