Your name as it appears on your passport:_________________________________________  
                                                                                                  First                                 Last
Date/Place of Birth_____________________________________________________________
                                                         Month    Day   Year           City                      Country
Of what country are you a citizen?________________________________________________

Of what country are you a permanent resident?______________________________________

If I am admitted as a student at the Philadelphia University:

1.      I will enroll in and attend at least 12 units of day classes each semester.

2.      I will not add or drop classes without the approval of the International Student Advisor.

3.      I will accept employment only when approved by Philadelphia University and when authorized in writing by the United States Office of Immigration and Naturalization.

4.      I agree to take an English language placement test before registering for any classes.

5.      If necessary, I will enroll in any class suggested by the university to improve my English ability.

I understand that if I fail to meet the above conditions or if I fail to maintain at least a "C" scholarship average, Philadelphia University will immediately notify the United States Office of Immigration and Naturalization that my approval has been canceled and that I will not be permitted to continue my study at Philadelphia University.

Having read and understood all of the above, I agree without qualification to these conditions.  

                            Signature: ____________________________________

                            Date: ________________________________________  

Please Return this form to:

International Admissions
Philadelphia University
School House Lane and Henry Avenue
Philadelphia, PA 19144-5497
U.S.A  

or fax to: 215-951-2907