English Language Institute Application

Biographical Information

First Name

Middle Name

Last Name

Alternate Last Name(s) (i.e. maiden name; if more than one, separate with commas)

Birthdate

Legal Gender

Female

Male

Primary Language Spoken

Address Information

Student Address

Country

Street

City

Region

Postal Code

Immigration Information

Country of Citizenship

Country of Birth

Country of Permanent Residence

Current Immigration Status Classification

Upload copy of Passport Photo Page

Upload Bank Statement

In order to be issued a Form I-20 or DS-2019, you will be required to complete and submit the 'Source of Funds' form.

Open this link now. https://www.millersville.edu/international/files/sourcesoffunds.pdf

Complete the 'Source of Funds' form after finishing THIS form.

I understand this application is not complete until I submit the 'Source of Funds' form.

Yes

No

Contact Information

Phone Number

Email Address

Application Information

Preferred Entry Term

Education Information

Are you seeking a degree from Millersville University?

Yes

No

Have you graduated from high school?

Yes

No

High School Start Date

High School Graduation Date

High School Website link

Upload Secondary School (High School) Academic Transcripts
(If admitted, official documentation will be required to enroll in university-level coursework)

Have you ever attended College or University?

Yes

No

Have you completed and obtained a bachelor's degree from a post-secondary institution?

Yes

No

Upload copies of Post-Secondary School (University)Academic Transcripts

Most Recent School Attended or Current College Name

Most Recent School Attended or Current College Website Link

Additional Information

Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion from the institution.

Be sure to look up any words in the paragraph above if you are unsure of how to answer, BEFORE your answer.

Yes

No

If yes - Please give the approximate date(s) of each incident, explain the circumstances and reflect on what you learned from the experience. You may use up to 400 words.

Have you ever been adjudicated guilty or convicted of a misdemeanor or felony? Note that you are not required to answer "yes" to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise required by law or ordered by a court to be kept confidential.

Be sure to look up any words in the paragraph above if you are unsure of how to answer, BEFORE your answer.

Yes

No

If yes - Please provide the details of your criminal conviction or adjudication and reflect on what you learned from the experience. You may use up to 400 words.

Consent for the Collections and Processing of Sensitive or Personal Data From the European Union for Admissions and Enrollment Purposes

Pursuant to the European Union General Data Protection Regulation (EU GDPR), the Pennsylvania State System of Higher Education and its member universities, including Millersville University of Pennsylvania (“University”), in its capacity as a data controller under the EU GDPR, must obtain explicit, affirmative consent before it can collect or process any sensitive or personal data for a lawful basis including for admission and enrollment purposes.
Sensitive data includes data revealing racial or ethnic origin; political opinions; religious or philosophical beliefs; trade union membership; genetic or biometric data; health data; or data concerning a person’s sex life or sexual orientation.
Any sensitive or personal data that is collected will be for the sole purpose of application for admission to the University that is sent from the EU and is necessary for that purpose or for any purpose permitting the use of sensitive or personal data under applicable law or to meet other compliance obligations of the University.
I understand that any sensitive or personal data that is collected will also be used to report serious illness, injury, or other health or emergency situations involving me, as well as to address or report discrimination, harassment, sexual or gender-based misconduct and criminal behavior which may be committed by or against me or otherwise involve me, on or off campus, to appropriate authorities including staff, faculty, and administrators of the University or appropriate legal or governmental authorities under applicable policies of the Pennsylvania State System of Higher Education or the University (including but not limited to applicable codes of conduct) and applicable laws (including but not limited to Title IX and the Clery Act).
I understand that refusal to consent to the use of sensitive or personal data, and the transfer of sensitive or personal data overseas, for the purpose outlined in this notice may make it impossible for the University to carry out necessary activities, and may preclude the University’s ability to provide requested services.
I understand I have the right to withdraw consent to the collection and processing of sensitive or personal data and to do so, I must contact [insert information for responsible person]. I also understand that the complete deletion of data will not be feasible in all situations to ensure the University’s ability to comply with regulatory requirements.

Do you agree to the above listed statements?

Yes

No

Signature

I certify that the answers I have given to all questions on this application are correct and complete to the best of my knowledge. I understand that falsification or omissions of information or credentials may result in revocation of admission. I authorize the release of my contact information and admission status, on file with Millersville University, to any financial sponsor who is requesting verification of admission.

In place of your signature, please type your full legal name: