University Contact Form

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* 1. Email Address:

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* 2. Family Name/Surname:

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* 3. Given Name:

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* 4. Preferred Name or Nickname:

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* 5. Gender:

Male

Female

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* 6. Date of Birth:

Date:

Date

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* 7. Phone Number (please include country code):

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* 8. What is your preferred way to communicate?

iMessage

Text

WeChat

Other (please specify)

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* 9. Physical Mailing Address:

Address Line 1

Address Line 2 (City and State/Province)

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* 10. Country of Residence:

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* 11. Country of Citizenship:

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* 12. Are you a U.S. Citizen, Green Card Holder/Permanent Resident of the USA?

U.S. Citizen

Permanent Resident / Green Card Holder

I am not a U.S. Citizen or a Permanent Resident/Green Card Holder.

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* 13. High School Name or Current University/College Name and Graduation Date:

High School Name or Current University/College Name

Graduation Date (MM/DD/YYYY)

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* 14. When do you plan to enroll?

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* 15. Are you enrolling in an undergraduate or graduate program?

I am seeking an undergraduate degree.

I am seeking a graduate degree.

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* 16. My major or chosen program of study (if undecided, please type 'Undecided' in the space below):

Business (i.e. Business Administration, Economics, etc.)

Computer Science (i.e. Cybersecurity, IT, etc.)

Engineering (Civil, Mechanical, Chemical, etc.)

Biomedical Sciences

Nursing

Education

Exercise Sciences

Other (please specify)

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* 17. SAT or ACT score (not required for all schools, but is required if you plan on applying for a scholarship):

I have an SAT score.

I have an ACT score.

I have not yet completed my SAT or ACT, but am interested in doing so.

I do not plan on taking the SAT or ACT.

Other (please specify)

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* 18. Primary Language used during High School or University education:

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* 19. TOEFL or IELTS Score:

I have not yet taken the TOEFL or IELTS.

My Score (please specify TOEFL or IELTS):

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* 20. Grade Point Average (GPA) or Academic Ranking:

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* 21. I am interested in learning more about the following AmeriStudy Member Universities (if you check ALL Member Universities, no need to check others):

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* 22. Referred By:

Online Search

CGE Website

University Website

AmeriStudy Contact Person/Recruiter - list name below

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* 23. Comment or Question:

100% of survey complete.