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: jesansiddiquey@gmail.com
*ConfirmEmailaddress: jesansiddiquey@gmail.com
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