1. Year: 2011-12 2012-13 2013-14
2. Term: Summer Fall Spring

1. Last Name:
2. First Name:
3. Middle Name:
4. Names different from previous that appear on your academic records:
5. Gender: Male Female
6. Birth Date: (MM/DD/YYYY)
7. Birth Place: (City,Country)
8. Country of Citizenship:
9. Are you an immigrant of another country? Yes No
10. If yes, what country:
11. E-mail:
12. Current Mailing Address: Number & Street, City, State or Country, ZIP or Postal Code
13. Dates you will be at this address: from DATE until DATE
14. If you are married, will your spouse be a student at Southern Utah University? Yes No Not Married
15. Dependents who will accompany you during the exchange: Name, Age, Relationship
16. Emergency Contact: Name, Relationship, Address, City, State or Country, ZIP or Postal Code, Email Address, Telephone Number

1. What major do you plan to study?
2. Have you ever attended Southern Utah University? Yes No
3. If so, when?

1. Source and proof of finances Self (will need to provide bank statement) Sponsor (will need to provide bank statement and letter of support)

I understand that I am applying for admission as a non-degree seeking (non-matriculated) student, and any credit I may earn as such will not be considered nor applied toward an SUU degree unless and until I complete the requirements for matriculation. Student matriculation (a student who has been formally admitted to work for a degree) can be achieved by completing a regular Southern Utah University application, and submitting necessary transcripts, test scores, processing fee, required GPA and meeting admission requirements. A maximum of 30 semester hours of credit as a non-matriculated undergraduate student may be counted toward a degree, and six hours (6) of graduate credit may be considered toward an advanced degree.

All the answers I have given in this application are complete and accurate to the best of my knowledge. If admitted, I agree to observe all the rules and regulations of Southern Utah University.

1. Signature: (by entering my name here, I am signing that I agree to the aforementioned conditions.)
2. Date: (enter today's date, another step of the signature process)
3. Prove submission comes from a person, what is 2+2?