KSI Distance Learning Application Form

For a printable (.pdf) copy of the application click here.

STUDENT APPLICATION FORM
Name: (First Name) ________________ (M.I.) ______ (Last Name) ___________________

Social Security Number: __________________________ (for domestic students only)

Mailing Address:

Street: ___________________________________________________________________

City: _______________________ State: _______ Zip Code: _______ Country: __________

Home Phone: ______________ Business Phone: ___________ E-mail: __________________

Application for: ( ) Full Time ( ) Part Time

( ) Master of Science Degree in Computer and Information Sciences
( ) Standard MS degree program (CIS)
( ) MS degree with concentration in Information Security (IS)
( ) MS degree with concentration in Bioinformatics (BI)
( ) MS degree with concentration in Knowledge Management (KM)
( ) MS degree with concentration in Software Engineering (SE)
( ) MS degree with concentration in Computer Networks (CN)
( ) MS degree with concentration in Management Information Systems (MIS)
( ) MS degree with concentration in Computer Art & Design (CA)
( ) MS degree with concentration in Computer-Based Education (CBE)

( ) Certificate Program in Computer and Information Sciences (CP)

( ) English Language Program (ESL)

Beginning in: ( ) Fall ( ) Spring ( ) Summer Semester, Year: 20_____

Academic Information:

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

Institution Major Degree Received Month/Year Attended From To
1.________________________________________________________________________
2.________________________________________________________________________
3.________________________________________________________________________
4.________________________________________________________________________

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

1.________________________________________________________________________
2.________________________________________________________________________
3.________________________________________________________________________
4.________________________________________________________________________

Experience:

Company/Organization Title/Position From To
1.________________________________________________________________________
2.________________________________________________________________________
3.________________________________________________________________________
4.________________________________________________________________________

Have you ever applied for admission to KSI? ( ) Yes, semester ____ year ____ ( ) No

Have you ever previously attended KSI? ( ) Yes, semester ____ year ____ ( ) No

How did you become interested in KSI?
( ) Teacher ( ) Friend ( ) Alumni ( ) A Current Student
( ) Internet ( ) Newspaper Ad ( ) Radio Ad ( ) TV Ad ( ) RTA Ad
( ) KSI Website ( ) google.com ( ) gradschools.com
( ) Peterson's Guide ( ) Patterson
( ) Other ___________________________

Are you a foreign student? ( ) Yes ( ) No

Are you applying for Financial Aid? ( ) Yes ( ) No

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

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).
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Optional Questions:
Gender: ( ) Male ( ) Female

Date of Birth (MM/DD/YY): _____________________

Ethnic Origin: (This information is optional and requested for purposes of Federal compliance agencies only and will not be used in determining admission status.)
( ) (B) African American ( ) (A) American Indian or Alaskan Native ( ) (W) Caucasian
( ) (H) Latin American ( ) (P) Pacific Islander or Asian American ( ) (N) Non-Resident (I-20)

I want to take the following distance learning courses:
course numbers: ________, ________, ________, _________

Signature of Applicant: ______________________ Date (MM/DD/YY): _____________

Application fee $40 paid: ( ) Yes ( ) No

Return this form with:
1. $40 Non-Refundable Application Fee
2. Official Transcript(s)* (*Photocopies of official transcripts are not accepted. The official transcripts must be released and sent directly to Knowledge Systems Institute's Admissions Office.)
3. Photocopy of Diploma
4. Three Reference Letters

Mail to:
Admissions Office
Knowledge Systems Institute
3420 Main Street, Skokie, IL 60076 USA
Tel: 847-679-3135 Fax: 847-679-3166
Email: office@ksi.edu http://www.ksi.edu

Office use only: