Applicant Information

Full Name Gloria del Carmen Guevara Alva

Family Name First Name Middle Name
Date of Birth 21/06/1964 Gender ☐ Male X Female
Country of Birth México City Country of Citizenship México

Garibaldi Square
Permanent Address Bulding 6 Interior D

(In home country) Puebla Puebla México 72490

City District or Providence Country Postal Code
Phone Number 2221890911 Local Phone Number (US)
Local Address
(In United States)
City State Postal Code
Email Address alvagueglo@hotmail.com
Marital Status X Single ☐ Married If Married, Name of Spouse
Nationality:

How were you referred to United States

University? Through my university, Benemérita Universidad Autónoma de Puebla, Mexico.

Immigration and Visa Information

Visa Type☐ F-1 ☐ F-2 X No Visa ☐ Other (Please explain)

Will your Spouse or Dependents require an I-20? (List Dependent s and Passport ☐ Yes X No
Number)
Name & Relationship Passport Number
Name & Relationship Passport Number
Name & Relationship Passport Number
Please attach Passports for all dependents
Family Information
Father’s Name Occupation
Address

Mother’s Name Occupation

Address

Emergency Care (Who may we contact in case of emergency?)

Please print name and phone number of a contact person in your home country and/or in the U.S.
US Contact: (Required) Name
Phone

Home Country Contact: Name Mario Maldonado Guevara

Phone 2225198630
Adapted from http://www.usuniversity.edu/international/International%20Student%20Admission%20Application.pdf
Start Session: _____________________

Select program of interest listed below:

Undergraduate Programs
 Undergraduate programs are offered Fall I only
☐ Bachelor of Arts in Management ☐ Bachelor of Science in Health Science
☐ General Management ☐ Health Education
☐ Entrepreneurship ☐ Health Services Administration
☐ Human Resources ☐ Gerontology
☐ Marketing
Graduate Programs- These are a twice a month weekend/hybrid schedule

X Master of Business Administration ☐Master of Science in Health Science- Specialization in Health Care Administration

☐ Master of Arts in Education –Specialization in Higher Education Administration

Master of Arts in Education is offered Fall I only

English Proficiency

Spanish
Is English your First Language? ☐ Yes X No If No, what is your Native Language? ___________________________________
How many years have you studied English in the past five years?
1 year____________________________

Health and Medical

NOTE: USU requires all international students to have health insurance for the duration of their program.
Do you currently have Health Insurance? Yes

To the best of your knowledge are you now in good physical and mental health? Yes

Personal Statement – explaining why you wish to study your chosen postgraduate course

In this way, I acquire more knowledge and I learn the English language at the same time.

Adapted from http://www.usuniversity.edu/international/International%20Student%20Admission%20Application.pdf

 Education Background Information

Are you a high school (secondary) graduate? X Yes ☐ No If “Yes,” list date of graduation 20/05/1982

In chronological order, list any secondary schools and colleges or universities that you have attended either in the U.S. or in
another country. If you attended more than two schools, give the necessary information on a separate page. You must provide
a diploma or other proof of graduation from a secondary school as well as copies of transcripts (with an English translation)
from any college or university that you have attended. Originals will be validated when you report for orientation.

Secondary School Name Colegio Esparza AC

Location 2 Sur 510
Dates Attended 19/05/1979
Major 20/05/1982
Diploma/Degree Received Certificate

College Name
Location
Dates Attended
Major
Diploma/Degree Received

College Name
Location
Dates Attended
Major
Diploma/Degree Received
List any additional schools and colleges on a separate sheet if needed.
Professional Experience
List professional experience relevant to your program starting with the most recent first.
Employer Construcciones Lague SA de CV
Location Puebla, Pue., México
Dates Employed 2008-2018
Job Title General counter

Employer
Location
Dates Employed
Job Title
List any additional employers on a separate sheet if needed.

Adapted from http://www.usuniversity.edu/international/International%20Student%20Admission%20Application.pdf