2012 ivsp application

8/16/2019 2012 IVSP Application

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W E L C O M E !

Dear Applicant:

Congratulations! You just took your first step to realizing your dream in participating and becoming a member

of Gallaudet University.

The International Visiting Scholar Program (IVSP) is a one- or two-semester non-degree program designed

for international school personnel, researchers, professionals, and students from other countries not desiring a

degree from Gallaudet University. The IVSP is individually designed to meet the needs of each scholar, in which

the participant can take a class for credit, audit a course, and/or gain practical experience by being exposed to

what is happening at Gallaudet University. There are also great opportunities to do intensive data collection in

acquiring specific information and skills relating to deafness.

As an IVSP student at Gallaudet University, you have the unique opportunity to achieve your personal and

professional goals in a barrier-free environment. Our liberal arts curriculum allows you to develop your

individual skills while preparing you to be a vital part of the increasingly globalized world. We hope you will

soon join our proud and strong community of excellence.

Your application and supporting documents represent who you are and what you have to gain and contribute to

and from our University. We encourage you to take the time necessary to make sure that these documents are a

complete and fair representation of your goals and interest in our IVSP program.

We welcome your application to the IVSP program and are available to assist you throughout the process. Please

contact us at:

+1-202-651-5815 (Voice);

+1-866-957-4317 (Video phone);

+1-202-448-6954 (Facsimile);

[email protected] (E-mail).

Thank you.


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MISSION STATEMENTS

Gallaudet University

Gallaudet University, federally chartered in 1864, is a bilingual, diverse, multicultural institution of higher education that ensures the

intellectual and professional advancement of deaf and hard of hearing individuals through American Sign Language and English.

Gallaudet prepares its graduates for career opportunities in a highly competitive, technological, and rapidly changing world.

Center for International Programs and Services

The Center for International Programs and Services at Gallaudet University facilitates global education and international exposure which

enriches the academic and cultural environment at Gallaudet and promotes extensive cross-pollination of ideas.

CONTACT INFORMATION


(202)651-5815 (tty/v)

(202)448-6954 (fax)

[email protected]

Web: http://cips.gallaudet.edu/

Residence Life - Housing

(202)651-5611(tty)(202)651-5255 (v)

(202)651-5757 (fax)

[email protected]

Web: http://www.gallaudet.edu/Student_Affairs/Residence_Life.html

Student Health Services

(202)651-5090 (tty/v)

(202)651-5743 (fax)

[email protected]

Web: http://www.gallaudet.edu/shs.html

Gallaudet University is an equal opportunity employer/educational institution and does not discriminate on the basis of race, hearing status,

disability, religion, color, national origin, age, sex, covered veterans status, marital status, personal appearance, sexual orientation, family responsibilities,

matriculation, political affiliation, source of income, place of business or residence, pregnancy, childbirth, or any other unlawful basis.


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APPLICATION INFORMATION AND CHECKLIST

IS THIS APPLICATION RIGHT FOR YOU?

You should apply for international undergraduate or graduate

admission if you are seeking a bachelor’s, master’s or doctorate

degree.

FINANCIAL AID/SCHOLARSHIPS

Financial aid and scholarship opportunities for international

students attending the IVSP at Gallaudet University are not

available. For the most part, international students are not

eligible for federal, state, or university aid or scholarships.

CAMPUS HOUSING

Before applying for on-campus housing, you must complete

your application for admission. Once your application is

complete and are accepted to the program, you will be mailed

your admission packet with On-Campus housing request form

included.

OFFICIAL ACT OR TOEFL TEST SCORES

The IVSP program requires that you are proficient in English.

If the language of academic instruction in your country does

not utilize the English language, submit at least one ACT orTOEFL or IELTS score set with your application.

OFFICIAL HIGH SCHOOL TRANSCRIPT

You must submit official record or transcript documentation

showing that you have completed an accredited secondary

school series equivalent to that of a United States high school.

OFFICIAL UNIVERSITY TRANSCRIPT

If you are currently attending a university or have completed a

degree program from a university, submit an official record ortranscript of all your current and previous academic course

work.

APPLICATION FEE

There is a nonrefundable $50 application fee payable by check(cheque), international money order, or credit card. The check

must be from a bank in the United States and must show the

United States mailing address of the bank. The check should be

made payable to Gallaudet University.

FINANCIAL STATEMENT

In order to obtain the immigration document needed to apply

for a student visa, you need to complete and submit the

Certification of Finances Form documenting proof of adequate

financial resources for your stay at Gallaudet University.

Financial documents must be dated and less than 6 months old

indicating value in United States dollars (US$).

STUDENT VISA ELIGIBILITY

The purpose of the Certification of Finances Form is to help

Gallaudet University obtain complete and accurate information

about the funds available for your studies at Gallaudet

University. The United States Citizenship and Immigration

Services (USCIS) regulations require all international

applicants or admitted students to provide evidence of adequate

financial support for their studies in the United States. You are

required to submit both the complete Certification of Finance

Form and original, official documents that show you havesufficient funds.

Once your Certification of Finances Form is submitted,

reviewed and approved, we will send you the immigration

document, Form I-20 or DS 2019 which you will need to apply

for a visa.

VISA INFORMATION

Please allow sufficient time when applying for admission to the

IVSP program, receiving your immigration documents, and

applying for a visa at a United States Embassy in your country.A reasonable time of between three to six months should be

sufficient. All international students applying for a visa are

required to pay a SEVIS fee. Proof of SEVIS fee payment must

be submitted at the visa interview. More information is

available at: www.ice.gov/sevis/i901.


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APPLICATION DOCUMENTS

Listed below are the items that need to be completed for

admission to the IVSP program at Gallaudet University. Check

to make sure each item has been sent to us. Your applicationcannot be reviewed until we receive all items on the list.

□ Completed IVSP Application Form

□ Application Processing Fee ($50)

□ Your goals statement - Complete both questions on a

separate paper.

□ High School Transcript (Secondary school transcript

and/or upper school transcript) or University

Transcript(s)

□

Two Letters of Recommendation - Must be submitted

from teachers, school administrators, employers, or

community leaders. Recommendation letters must

describe your academic motivation, leadership potential

and your ability to succeed in a challenging college

environment

□ Audiogram

□ An applicant can be admitted to the IVSP withoutsubmitting proof of English language proficiency. However,

to enroll in a college-level course, you must demonstrate

proficiency in English, by meeting any of the following

conditions: International TOEFL score of 61 (iBT) /173 (CBT)

/500(PBT) or higher.

Academic placement on the Gallaudet University

English Language proficiency examination.

APPLICATION/CREDENTIAL DEADLINES

Fall Semester ……………… June 31

Spring Semester ……..……..… October 30

PLEASE NOTE: The application, application fee, and all

supporting credentials must be submitted by these dates. Only

complete applications will be reviewed for admission to the

University. All academic records and supporting documents

must be official. If only one original is available, a copy attested

or certified by the institution may be submitted. A certified,

literal English translation must accompany the original

document if not in English. Please read the instructions on the

following pages carefully and complete all necessary steps.

Please make a photocopy of your application forms, documents,

and essays for your record.


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BIOGRAPHICAL INFORMATION

Please print (write in block letters) and as printed on your birth certificate and/or passport)

Mr. Ms. Mrs.

Last Name (surname/family name): _________________________________________________________________________________

First Name (Given name): ________________________________________________________________________________________

Middle name (other names): _______________________________________________________________________________________

Gender: Male Female

Date of Birth: Month _______ Day _______ Year _______ City of Birth: _________________________________________________

Country of Birth: _____________________________________ Country of Citizenship: _______________________________________

CURRENT MAILING ADDRESS

Street:

________________________________________________

P.O. Box/Apartment Number:

________________________________________________

City:

________________________________________________

State/Province:

________________________________________________

Zip/Post Code:

________________________________________________

Country:

________________________________________________

Telephone:

________________________________________________

country code and number

Fax:

________________________________________________


E-mail:

________________________________________________

PERMANENT ADDRESS

Street:

________________________________________________

P.O. Box/Apartment Number:

________________________________________________

City:

________________________________________________

State/Province:

________________________________________________

Zip/Post Code:

________________________________________________

Country:

________________________________________________

Telephone:

________________________________________________


Fax:

________________________________________________


E-mail:

________________________________________________


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FAMILY INFORMATION (Emergency Contact)

FATHER/LEGAL GUARDIAN CONTACTS

Father/Guardian Full Name:

______________________________________________________________________________________________________________

Last name First name Middle name

Address:

______________________________________________________________________________________________________________

City: State/Province:

__________________________________________________________ _____________________________________________

Zip/Post Code: Country:___________________________ ______________________________________________________________________

Telephone: FAX:

________________________________________________ ______________________________________________________

country code and number country code and number

E-mail: _______________________________________________________________________________________________________

MOTHER/LEGAL GUARDIAN CONTACTS

Mother/Guardian Full Name:

______________________________________________________________________________________________________________

Last name First name Middle name

Address:

______________________________________________________________________________________________________________

City: State/Province:

__________________________________________________________ _____________________________________________

Zip/Post Code: Country:

___________________________ ______________________________________________________________________

Telephone: FAX:

________________________________________________ ______________________________________________________

country code and number country code and number

E-mail: _______________________________________________________________________________________________________


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Make a copy for your records.Return all forms to: Gallaudet University, Center for International Programs and Services, Washington, DC 20002-3695, USA.

(202) 651-5815; (202) 448-6954 FAX; [email protected].

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HEARING STATUS

Are you: Deaf Hard of Hearing Hearing?

If Deaf, type of amplification used: Hearing Aid(s) Cochlear Implant None

Age at onset of your hearing loss? _____________ Cause of your hearing loss ________________________________________________

SIGN LANGUAGE INFORMATION

How long have you been using sign language? ________________________________________________________

Please rate your ability to communicate in sign language: Native Good Fair Poor None

The amount of time you communicate in sign language: 100% 75% 50% 25% Never

If you are a new signer and are admitted to the University, would you be interested in attending our New Signers Program (The New

Signers Program is offered only in August.)? Yes No

OTHER INFORMATION

Do you plan to live on campus? Yes No

How did you find out about our program? (check all that apply)

Alumnus/Alumna Home visit Gallaudet View book Internet Counselor Family

Mail Friend Newspaper/Magazine Teacher While visiting D.C.

Students at Gallaudet University Visiting faculty/staff from Gallaudet University

Other (explain): _______________________________________________________________________________________

Have you ever applied to our program before? Yes No

If yes, were you accepted? Yes No

If yes, did you enroll? Yes No

Please list other names used: _____________________________________________________________________

The following information is confidential and will not affect the consideration of your application. It will allow us to better serve your

individual needs. Your response is optional.

Do you have any additional disabilities? Yes No

If you have any additional disabilities, Gallaudet University’s Office for Students With Disabilities (OSWD) would like to serve you.Please list your disability and the specific needs you may have, such as large print books, mobility training, braille materials, etc.:

______________________________________________________________________________________________________________

________________________________________________________________________________________________________

vvv


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POST-SECONDARY EDUCATION INFORMATION

EDUCATIONAL BACKGROUND

Begin with most recent school/university attended. Submit official transcript from every school. Photocopies of transcripts will not be

accepted. Allow three weeks mailing time when sending transcripts from other schools/universities to Gallaudet University.

1)

Current School

Department/Faculty Name: _________________________________________________________________________

Address: _________________________________________________________________________________________

City: __________________________________________________ State/Province: _____________________________

Zip/Postal Code_____________________________________ Telephone: _____________________________________


Fax _____________________________ School Contact E-mail: _____________________________________________


Dates Attended: From (month/year): ________________________ To (month/year): ___________________________

2)

Other School

Department/Faculty Name: _________________________________________________________________________

Address: _________________________________________________________________________________________

City: __________________________________________________ State/Province: _____________________________

Zip/Postal Code_____________________________________ Telephone: _____________________________________


Fax _____________________________ School Contact E-mail: _____________________________________________


Dates Attended: From (month/year): ________________________ To (month/year): ___________________________

Send all transcripts and catalogs to: Gallaudet University

800 Florida Ave. NE


Washington, DC 20002-3695, USA


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Page 10 of 18

STATEMENT OF GOALS

Instructions: There are limitations to what grades, test scores, and recommendations can tell us about any applicant. Your answers to

the following questions will help us learn more about you so we can fairly evaluate your academic commitment and readiness for our

program. We hope that in writing these essays you will reflect on your attitudes, values and perceptions. Please answer both questions

completely, using additional paper.

Essay Question One: Write a brief description of your educational background and experiences with Deaf people.

Essay Question Two: Specify your goals and areas of interest (be as specific as possible)

How did you hear about the program?


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AUDIOLOGICAL RECORD (to be completed by deaf or hard of hearing applicant only)

PART A:




Gender: Male Female Date of Birth: Month ____ Day ____ Year ____

E-mail:________________________________________________________________________________________________________

If you already have an audiogram that is less than two years, attached it to this form, otherwise, provide this form to your audiologist/doctor

for a new audiology examination.

PART B (to be completed by certified audiologist):

Onset of hearing loss: Birth Other___________ Cause:____________________________________________________________

Month/Year

2. Pure tone:

Date Administrator Indicated

Standard

Used:

ISO-ANSI

1.

Right Ear

Frequency 125 250 500 700 1000 2000 3000 4000 6000 8000

Air

Hearing Level

Bone

Left Ear

Frequency 125 250 500 700 1000 2000 3000 4000 6000 8000

Air

Hearing Level

Bone

Name: _____________________________________________________ Title/Position: _______________________________________

Agency: _______________________________________________________________________________________________________

Address: ______________________________________________________________________________________________________

City: __________________________________________________________________________________________________________

State/Province: ________________________________________________ Zip/Postal Code __________________________________

Telephone: ___________________________________________ Fax: _____________________________________________________

E-mail:________________________________________________________________________________________________________


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APPLICANT CERTIFICATION

I understand that falsifying or withholding information in completing this application may result in the cancellation of my admission to

the IVSP Program and/or registration. I certify that the information provided in this application is true and correct.

Name (please print in block letters): ________________________________________________________________________________

Signature:_________________________________________________________ Date:_______________________________________


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APPLICATION PAYMENT

The nonrefundable $50 application fee is required and will not be waived. Applications arriving without the application fee will be

considered inactive and will not be processed.

Bank Check (Cheque) or International Money Order. Checks/money orders must be in US dollars.

(Attach check (cheque) or money order here)

Amount: US $50.00

Payable to: Gallaudet University

Credit Card. If you wish to pay by credit card (Visa or Master Card only), complete all information below.

Credit Card Type: VISA Master Card Amount; US $ 50.00

Card Number:__________________________________________________ Expiration Date:__________________________________

Name on Account (please print):____________________________________________________________________________________

Card Owner Signature:______________________________________________ Date:_________________________________________


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CERTIFICATION OF FINANCES

2012 - 2013 Academic Year

The United States Citizenship and Immigration Services regulations require all international student applicants to provideevidence of adequate financial support before they may obtain a student visa. To demonstrate that you have adequate financial

support, you must complete and send this form and original, official documents that show you have sufficient funds to pay at least

the fixed/estimated costs of one semester or two semesters. Listed below are the fixed/estimated costs for international students in

the undergraduate and graduate programs at Gallaudet University.

Fixed University Costs for Academic Year 2012-2013 (August 2012 - May 2013) Undergraduate Program Graduate Program

Tuition $24,860.00* $27,360.00*

Health Insurance & Service Fee $2,200.00 $2,200.00

Unit Fee $276.00 $276.00Room & Board $10,790.00 $10,7900.00

Books & Supplies $1,000.00 $1,000.00

TOTAL (one academic year) $39,126.00 $41,626.00

*This reflects the international surcharge at 100%. This tuition is mandated by the U.S. Government.

Note: This information is provided as a guide only and is not considered a contract or as binding on the University. The

University reserves the right to change tuition costs, fees, and other charges at any time without notice.

Estimated Additional Costs: You should plan to have at least $2,000 for personal expenses each academic year. If you plan to stay

at Gallaudet through the winter and summer vacation periods, you will need an additional $3,000. If your family will stay withyou while you are a student, plan an additional $5,000 for your spouse and $3,000 for each child.

Summer School: Gallaudet offers additional courses during summer school (May-August). Most academic programs do not

require students to take summer school courses. Summer school courses require additional tuition and fees. Consult the Student

Accounts office for a list of these additional charges.

Documentation of Financial Support: Listed below are the sources of support you can use to demonstrate adequate financial

support. The total amount of funds shown in these supporting documents must equal or exceed the fixed costs for one academic

year in your chosen program (see table above). You must obtain two original, official copies of each supporting document .

Attach one copy of each document to this Certification of Finances Form and send it to Global Education and Scholar Services

(GESS) at Gallaudet University. When your documents are received and approved, GESS will send you a completed Form DS-

2019. You will take the Form DS-2019 AND your second official copy of the supporting documents to the United States Embassy

or Consulate in your country to apply for your student visa. Canadian students do not need a student visa.


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CERTIFICATION OF FINANCES

2012 - 2013 Academic Year

Please Type or Print Clearly - This information will be used for your DS-2019

Full Legal Name:

Mr. Ms. Mrs.




Gender: Male Female

Date of Birth: Month ______ Day ______ Year ______ City of Birth: ____________________________________________________

Country of Birth: ______________________________________ Country of Citizenship: ______________________________________

Mailing Address: _______________________________________________________________________________________________

Number/Street

______________________________________________________________________________________________________________

Number/Street2

______________________________________________________________________________________________________________

City State/Province Zip Code/Postal Code Country

Phone: ___________________________________________________ Fax: _________________________________________________

area code/country code & number area code/country code & number

E-mail: _______________________________________________________________________________________________________

Start date you expect to start your IVSP program: _______/_______/______ (mm/dd/yyyy)

End date you expect to complete your program: ______/_______/_______ (mm/dd/yyyy)

VISA INFORMATION (if you are already in the United States):

If you are currently on a F-1 or J-1 status at another institution in the U.S., your status is: F-1 (I-20) J-1 (DS-2019)

College Name: __________________________________________________________________________________________________

Please enclose photocopies of the following documents. Passport and Visa Stamp in passport

I-94 Card (both sides)

Form DS-2019 or I-20 or other immigration documents (both sides)

Will you request Gallaudet University to issue the Form DS-2019 or I-20? Yes No If yes, F-1 or J-1


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CERTIFICATION OF FINANCES – Continued

Indicate below your sources of financial support, OTHER than from Gallaudet University, and attach documentation from each

source. The period covered can be for more than one semester.

Source Amount

Available

Required Documents

Student Funds $ 1. Bank statement for checking, savings and/or accessible accounts

2. Certificates of deposits, mutual funds, stocks or bonds

Support Available from Family/Friends $ 1. Complete the Sponsors Affidavit of Annual Cash Support

2. Bank statement for checking and/or savings

3. Certificates of deposits, mutual funds, stocks or bonds.

Support Available from Sponsors $ 1. Complete the Sponsors Affidavit of Annual Cash Support

2. Official letter from sponsor’s employer showing annual earnings

Your Government/Embassy $ 1. Official Letter

Charitable Organizations/School

Scholarship

$ 1. Official Letter

OSAP/Canada Students Loan/VR/

Others (Canadians only)

$ 1. Official Letter

Applicant Certification

I hereby certify that the total amount of money that I have available for my first academic year at Gallaudet University is

US$____________________. Further, I certify that the information I am providing is correct and complete, and that I will

notify Gallaudet University of any changes in my financial circumstances. I understand that if I am a tourist without a

student visa and/or Form DS-2019, I cannot register as a student at Gallaudet University.

___________________________________________________________ ____________________________________

Signature Date (MM/DD/YYYY)

Attach Official Award Letter




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GUIDE TO SPONSORS AFFIDAVIT OF ANNUAL SUPPORT What does affidavit mean?

By completing this affidavit, you (sponsor) are sworn to the United States government that you will support with a specific amount of

money from your own financial resources, each year of the student’s studies and residence at Gallaudet University in the United States of

America. Please note that you also must attach a document with proof to show that you are sworn to support that student every year.

By signing the affidavit, you are making a financial commitment to the student that you must not break. Sponsors who fail to provide the

sworn support will force students to leave school. Do not expect that the student will be able to help support the costs through

employment. Employment is strictly controlled by the Immigration Service and is very limited.

How to complete the enclosed Sponsor’s Affidavit of Annual Cash Support Form:

□ Fill out the affidavit form in ENGLISH!

□ Promise to give only as much money as you can afford. The most common reason we reject affidavits is we do not believe a sponsor

can pay the amount of money as promised.

□ Attach proof of financial capability document(s) as explained below.

□ Sign the affidavit in front of a notary public, court registrar or other appropriate official in your country.

Proof of Financial Capability Documents:

You must prove that you are financially capable to support EACH YEAR of your student’s studies by attaching a proof of income

document and a bank statement. (If one of these documents is not attached, your affidavit will not be considered).

□

Proof of Income Document. This must be on your employer’s business stationery, on income tax returns or receipts, or estimatesby a bank with a private account if you are self-employed. The income of your company will not be accepted as proof of income.

You must provide an official statement of the salary paid to you or it must be on your tax returns.

□ Bank Statement must be in your name and your statement must state the following information: Date when your account was

opened, current balance in U.S. dollars or its equivalent, average deposits and average balances. We cannot accept statements that

do not specify balances unless it is stated to be a minimum of USD 100,000. If another person’s name appears on your bank

statement, that person must complete a separate affidavit or submit a notarized statement permitting those funds to be considered as

financial support for the student.

Documents must be:

□ Current (less than two months old)□ In English

□ Notarized


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SPONSORS AFFIDAVIT OF ANNUAL CASH SUPPORT

THIS IS MY SWORN PROMISE OF CASH SUPPORT

I (NAME), _____________________________________________________________________, PROMISE THAT I CAN AND

WILL GIVE NO LESS THAN U.S. $ _______________________________________ IN CASH FOR EVERY YEAR OF THE

STUDENT’S PROGRAM OF STUDY AT GALLAUDET UNIVERSITY TO (NAME OF STUDENT):

________________________________________________________________________________________________________

My relationship to the student is ______________________________________________________________________________

My address is _____________________________________________________________________________________________

________________________________________________________________________________________________________

Phone: ___________________________________________ Fax: ___________________________________________

E-mail: _________________________________________________________________________________________________

The following persons are fully or partially dependent upon me for their support. (Do not include the student named above).

Name Relationship to me Age

______________________________________________________ _________________________ ____________

______________________________________________________ _________________________ ____________

______________________________________________________ _________________________ ____________

______________________________________________________ _________________________ ____________

Name of my Employer: _________________________________________________________________________________Annual Salary: ___________________________________ (USD) Other Income: _________________________________(USD)

My proof of income document and bank statement is attached: Yes No

I swear that the information I have provided above is true and correct.

________________________________________________________________________________________

Signature of Sponsor

Sworn and subscribed before me this day: ______________________________________________________

________________________________________________________________________________________Signature of Notary Public/Court Registrar