KNOWLEDGE SYSTEMS INSTITUTE

STUDENT APPLICATION FORM

Name :					Social Security No.:
	(First-Name)	(M. I.)	(Last-Name)
Email :				Date of Birth:
Gender: q Male q Female			Marital Status: q Married q Single

Current Address:

Street:

City:

State/Province:

Zip code:

Country:

Home Phone :

Business Phone :

Permanent Address (international address):

Street:

City:

State/Province:

Zip code:

Country:

Home Phone :

Biographical – please check all that apply :

q U.S. citizen q Non-U.S. citizen: Country of citizenship:

q U.S. Resident Alien (Green Card Holder). If yes, you must submit a photocopy of your Alien registration card (I-551 Both sides) at the time of application to KSI.

Application for :

q Full Time q Part Time

q Master of Science Degree in Computer and Information Sciences

q	Standard MS degree program (CIS)
q	MS degree with concentration in Information Security (IS)
q	MS degree with concentration in Bioinformatics (BI)
q	MS degree with concentration in Knowledge Management (KM)
q	MS degree with concentration in Software Engineering (SE)
q	MS degree with concentration in Computer Networks (CN)
q	MS degree with concentration in Management Information Systems (MIS)
q	MS degree with concentration in Computer-Based Education (CBE)
q	MS degree with concentration in Digital Art (DA)

q Certificate Program in Computer and Information Sciences (CP)

q English Language Program (ESL)

Beginning in q Fall q Spring q Summer Year: 20___

Academic Information:

List, indicating most recent first, ALL academic institutions BEYOND the secondary level that you attended or are presently attending:

Institution Name & Location

Major

Degree

Received Month/Year

Years of Attendance From To

1.

2.

3.

List all computer related courses, if any, for which you are currently registered:

1. 2.

3. 4.

Experience:

Company/Organization

Title/Position

How long have you been with this Company From To

1.

2.

3.

Please answer all the questions below:

Have you ever applied for admission to KSI? q Yes q No If yes, semester ________ year ____

Have you ever previously attended KSI? q Yes q No If yes, semester ________ year ____

How did you become interested in KSI? q Friend q Alumni q Newspaper, please specify:_____________
q Internet , please specify site or search engine:_______________

q KSI Website q google.com q gradschools.com

q Peterson’s Guide q Patterson q Other: ____________________

Are you applying for Financial Aid? q Yes q No

Have you taken TOEFL Test? q Yes q No TOEFL score: _____ test date (MM/DD/YY): ________

Have you taken GRE/GMAT Test? q Yes q No GRE/GMAT score: ___________
test date (MM/DD/YY):________

References:

Name & Title	Address	Relationship
1.

2.

3.

Professional Statement:

Briefly explain why you desire study and what your plans are for a professional career (you may use a separate piece of paper if space is not sufficient).

Statistical Questions^V:

Ethnic Origin: q (B) African American q (A) American Indian or Alaskan Native q (W) Caucasian

q (H) Latin American q (P) Pacific Islander or Asian American q (N) Non-Resident (I-20)

V This information is requested for purposes of Federal Compliance Agencies only and will not be used in determining admission status.

Signature of Applicant: ____________________________ Date (MM/DD/YY): ___________

Application fee $40 paid: q Yes q No

Return this form with: · $40 Non-Refundable Application Fee · Official Transcript(s)* (Photocopy not accepted) · Photocopy of Diploma · Three Reference Letters · Affidavit of Support (International Students Only) · 1” to 1 ½” standard photo (Online student only)

Admissions Office Knowledge Systems Institute 3420 Main Street Skokie, IL 60076 TEL: 847-679-3135, FAX: 847-679-3166 email: office@ksi.edu http://www.ksi.edu

* Photocopies of official transcripts are not accepted. The official transcripts must be released and sent directly to Knowledge Systems Institute Admissions Office.

Office use only: