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EMU Undergraduate Admission Application

Jesan Ahmed Siddiquey, a male from Bangladesh, applied for undergraduate admission to Eastern Michigan University for the Fall 2016 semester as a freshman pursuing a major in Computer Science - Applied. He completed high school in Bangladesh in 2012 and obtained his GED in January 2016. Siddiquey is a citizen of Bangladesh and expects to obtain an F1 student visa. He provided his permanent address and contact information in Bangladesh. Siddiquey answered questions about his background and certified that the application was complete and accurate.

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Mahfuz A. Azim
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114 views3 pages

EMU Undergraduate Admission Application

Jesan Ahmed Siddiquey, a male from Bangladesh, applied for undergraduate admission to Eastern Michigan University for the Fall 2016 semester as a freshman pursuing a major in Computer Science - Applied. He completed high school in Bangladesh in 2012 and obtained his GED in January 2016. Siddiquey is a citizen of Bangladesh and expects to obtain an F1 student visa. He provided his permanent address and contact information in Bangladesh. Siddiquey answered questions about his background and certified that the application was complete and accurate.

Uploaded by

Mahfuz A. Azim
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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5/18/2016 PrintApplication

UndergraduateAdmissionApplication

ApplicantName
Requiredfieldsaremarkedwithanasterisk(*).
*LastorFamilyName: Siddiquey
*FirstorGivenName: JesanAhmed
ApplicantOtherNames
Listothernamesbywhichyouareknown(i.e.maidenname,otherversionsofyourname).Includeacompleteentrywithyourlast,first
andmiddlenames:
BiographicalInformation

Gender: Male
BirthMonth: 03
BirthDay: 17
BirthYear: 1994
EthnicityInformation
Whatisyourrace?Youmayselectoneormoreraces.
Race

Asian
EthnicityQuestion
AreyouHispanicorLatino?: No
CurrentResidence

IliveoutsidetheU.S.orCanada
ContactInformation
Requiredfieldsaremarkedwithanasterisk(*).
Address
Pleaseenteryourpermanenthomemailingaddress.
ParentContactInformation
OptionalinformationtobeusedbyEMUforemergenciesand/oroccasionalinformationupdatesduringtheapplicationprocess.
InternationalContactInformation
Requiredfieldsaremarkedwithanasterisk(*).
InternationalAddress
Pleaseenteryourpermanenthomemailingaddress.
*Street1: Road4,House5,ShahjalalUposhor
*City: Sylhet
ZipCode/PostalCode: 3100
*Country: Bangladesh
InternationalHomePhoneNumber
InternationalMobilePhoneNumber
Byprovidingthisinformation,youagreetoallowEMUtosendyouanoccasionaltextmessage.Customarytextmessageratesmayapply.
Countrycode: +88
Phonenumber: 01723901994
Email
*PersonalEmailaddress: [email protected]
*ConfirmEmailaddress: [email protected]
InternationalParentContactInformation
OptionalinformationtobeusedbyEMUforemergenciesand/oroccasionalinformationupdatesduringtheapplicationprocess.
https://axiomforms.emich.edu/AxiomWeb/PrintApplication.aspx?SourceID=4 1/3
5/18/2016 PrintApplication
BasicApplicationInformation
Requiredfieldsaremarkedwithanasterisk(*).
*Selectanapplicationtype(Noteinternationalstudents
seekinganF1orJ1visacannotapplyforadmissionasanon Freshman(FirstTimeinCollegeorUniversity)
degreestudent):
*Selectthesemesterforwhichyouareapplying: Fall2016
*HaveyoupreviouslyappliedtoEMU?: No
*HaveyoucompletedanycoursesatEMU?: No
*Selectyouragegroup: 2123Years
*Areyouapplyingtoafullyonlineprogram?: No
FreshmenandTransfer
Requiredfieldsaremarkedwithanasterisk(*).
*Anticipatedmajor: ComputerScienceApplied
CitizenshipStatus

IamnotaU.S.citizen
NonCitizenInformation
Requiredfieldsaremarkedwithanasterisk(*).
*Countryofcitizenship: Bangladesh
*Countryofbirth: Bangladesh
DoyouhaveavalidU.S.Permanent
No
ResidentCard?:
Idonotcurrentlyhaveavisa
Ifnotapermanentresident,expected
F1F1VisaStudent,Academic
visastatus:
AreyoucurrentlyresidingintheUS?: No
PermanentAddressinHomeCountry
IfyouarecurrentlyonorexpectingtoreceiveanF1orJ1visa,enteryourpermanentaddressinyourhomecountry.TheU.S.Department
ofHomelandSecurityrequiresthatthisaddressbelistedonyourI20orDS2019form.
Street1: Road4,House5,ShahjalalUposhahar
City: Sylhet
Country: Bangladesh
ZipCode/PostalCode: 3100
PermanentPhoneNumberinHomeCountry

EducationalBackgroundHighSchool
Listallhighschoolswhereyouhavepreviouslyattendedorattemptedcredit.Failuretoreportallinstitutionsattendedwillinvalidateyour
applicationandmayresultindismissal,ifyouhavebeenadmitted.

HighSchoolQuestions
HaveyoubeenhomeschooledintheUS?: No
Doyouhave,ordoyouintendtohaveaGED?: Yes
Ifyes,dateobtained(MM/YYYY): 01/2016
LastHighSchoolAttended
Listthehighschoolorsecondaryschoolyoumostrecentlyattendedorcurrentlyattend:
Schoolname(no Schoolcity:
SylhetInternationalSchool Sylhet
acronyms):
Schoolcountry: Dateofgraduation/exit
Bangladesh examactualorexpected 01/2012
(MM/YYYY):
DatesattendedTo
01/2012
(MM/YYYY):
OtherQuestions
Requiredfieldsaremarkedwithanasterisk(*).
MilitaryService
*HaveyouservedintheU.S.armedforces?(Ifyes,pleaseprovide
anofficialcopyofyourSMARTORAARTtranscript.Thetranscript
https://axiomforms.emich.edu/AxiomWeb/PrintApplication.aspx?SourceID=4 2/3
5/18/2016 PrintApplication
shouldbesenttoEMUinasealedenvelopefromthemilitary No
branch.Wewillevaluateyourmilitarytranscriptandawardcollege
creditifapplicable.):
ServiceFromDate ServiceToDate
(MM/YYYY): (MM/YYYY):
MiscellaneousQuestions
Haveeitherofyourparentsgraduatedfromcollege?: No
Ifyes,haveeitherofyourparents(biological,stepor
No
adoptive)graduatedfromEasternMichiganUniversity?:
DisciplinaryQuestions
EasternMichiganUniversity'sapplicationincludesthefollowingquestionsregardingpriorcriminalconvictionand/ordisciplinaryhistory,and
theinformationprovidedbythestudentmaybeconsideredwhenmakingthedecisionastowhethertoadmitthestudenttotheuniversity.
*Haveyoueverbeenconvictedofacriminaloffense
otherthanaminortrafficviolation,orfoundtobe
No
delinquentbyajuvenilecourt,orarethereanysuch
chargescurrentlypendingagainstyouatthistime?:
*Haveyoueverbeenexpelled,suspended,placedon
probation,orbeensubjecttoanyotherdisciplinary
No
actionatanysecondaryschoolorcollegeyouhave
attended?:
ApplicationFeeQuestions
Requiredfieldsaremarkedwithanasterisk(*).
Pleaseselectthemethodyouwillusetosatisfytheapplicationfee:

Iwillpaythenonrefundable$35applicationfeewithacredit
card.
ApplicationFeeWaiverEventBased
ThankyouforparticipatinginourEMUAdmissionsevent.Yourapplicationfeehasbeenwaived.Thisfeewaiverisgoodforonecalendar
yearandcoversthisapplicationonly.Thefeewaivermaynotbetransferredtoanyotherperson.

BysubmittingthisapplicationIcertifythatallinformationinthisformiscompleteandaccuratetothebestofmyknowledge,andthatI
havelistedallinstitutionspreviouslyattended.Iunderstandthatmisrepresentationoromissionofanyinformationmaybecausefordenial
orcancellationofadmissionormayresultinmybeingdismissedfromEasternMichiganUniversity,ifdiscoveredsubsequent.Iunderstand
thatallpertinentrulesandpoliciesofEasternMichiganUniversityapplytomeimmediatelyuponadmissionandthatitismyresponsibility
tobecomeknowledgeableaboutthem.Iunderstandthatallcredentialssubmittedinsupportofthisapplicationbecomepropertyofthe
Universityandarenotreturnable.
ApplicationFeePayment
BysubmittingthisapplicationIcertifythatallinformationinthisformiscompleteandaccuratetothebestofmyknowledge,andthatI
havelistedallinstitutionspreviouslyattended.Iunderstandthatmisrepresentationoromissionofanyinformationmaybecausefordenial
orcancellationofadmissionormayresultinmybeingdismissedfromEasternMichiganUniversity,ifdiscoveredsubsequent.Iunderstand
thatallpertinentrulesandpoliciesofEasternMichiganUniversityapplytomeimmediatelyuponadmissionandthatitismyresponsibility
tobecomeknowledgeableaboutthem.Iunderstandthatallcredentialssubmittedinsupportofthisapplicationbecomepropertyofthe
Universityandarenotreturnable.

*IunderstandIamapplyingasanewstudentortoan
additionalprogramatEasternMichiganUniversityandthatthe
applicationprocessingfeepaymentIammakingisnonrefundable.

DateSubmitted:5/18/2016

https://axiomforms.emich.edu/AxiomWeb/PrintApplication.aspx?SourceID=4 3/3

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