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WILLIAM JESSUP UNIVERSITY

International Graduate Student Admission Application

Admission Process STEP 1 Submit completed International Graduate Student Admission Application packet with $50 (US) non-refundable application fee, and other required documents (See “Application Checklist” for complete list) to the International Programs Office (IPO).

STEP 2 You will be contacted within approximately 1 week confirming whether your application has been accepted. If the application is incomplete, you will be requested to submit the missing/incomplete documents.

STEP 3 If you are admitted, you must prepare to submit the tuition, fees and optional housing payment for the first semester prior to the start of the semester.

STEP 4 A letter of acceptance and all necessary immigration documents will then be issued to you.

Application Checklist

  • Supplemental International Graduate Student Admission Information Form with $50 non- refundable application fee (completed with applicant signature)

  • Copy of Valid Passport

  • Official Transcripts (from all colleges and universities attended) May need to be evaluated.

  • Personal Essay (500 words)

  • MBA students must include a resume or curriculum vitae
  • Suggested TOEFL Score IBT 95+ or IELTS Academic Score of 7.0*

*Other proof of English Proficiency may substitute for TOEFL or IELTS score.

  • Financial Documents:

    • Financial Support Declaration

    • Bank Statement

  • Health Documents:

    • Student Statement of Health

    • Medical Examination (with Physician’s signature)

  • International Student Agreement Form

Please mail all application materials to: International Graduate Programs Office (IPO) William Jessup University

2121 University Ave Rocklin, CA 95765 (USA)

Email: [email protected] Phone: (916) 577-3220

Application Deadlines

Page 1 of 11

Semester

Application Deadline

Spring 2017

November 15, 2016

Summer 2017

March 15, 2017

Fall 2017

May 15, 2017


WILLIAM JESSUP UNIVERSITY

International Graduate Student Admission Application

Please type or print responses in English in blue or black ink. ALL QUESTIONS MUST BE ANSWERED COMPLETELY OR YOUR ADMISSION MAY BE DELAYED.

Term for which application is being made: Spring Summer Fall 2018

How did you hear about William Jessup University?

Personal Data

Full Name: Panditaradhyula Shiva

(Family Name) (First Name) (Middle Name)

Sex: Male Female

Date of Birth: 09/27/1989

(Month/Day/Year)

Home Country Phone Number: +91-9100654259

Country of Birth: INDIA Country of Citizenship: INDIA

Permanent Address (in home country):


11-13-783/3, Flat Number:101, Sri Sai Nidhi Appts, Green Hills Colony, Kothapet

Hyderabad Ranga Reddy District INDIA

(City) (District or Province) (Country)

Marital Status: Single Married Are you planning to be? No

Email Address: [email protected]

Ethnicity, Race, and Religious Affiliation (Optional-if supplied, this information will be used for statistical information only.)

Asian

Black or African American Hispanic//Latino

Two or More Races _

Native Hawiian or Other Pacific Islander White American Indian or Alaska Native _

Name of Church you attend Denomination

Immigration and Visa Information

Visa Type: No Visa F-1 F-2 F-3

Other (Please explain):

Family Information

Father’s Name: P. Seshu Babu Occupation:

Mother’s Name: P. Lalitha Occupation: House Wife

Address:


11-13-783/3, Flat Number:101, Sri Sai Nidhi Appts, Green Hills Colony, Road Number-3, Kothapet, Hyderabad, 500035, INDIA

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.

U.S. Contact (optional): Suhas Seerla 408-908-9049

(Name) (Phone)

Home Country Contact: Karthik Vazeer +91-9966959645

(Name) (Phone)

Educational Background

In chronological order, list any 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 transcripts (with an English translation) from any college or university that you have attended.

Institution #1 Institution #2

Name

JNTUH

SVU

Location

Hyderabad, INDIA

San Jose, California, United States of America

Dates Attended

2007-2011

2014-2015

Major

Bachelor’s

Master’s

Degree Received

Mechanical Engineering

Computer Science

Program of Study Master of Arts in Business Administration: Check here ( )

Optional Concentration: (Check if applicable)

Information Systems & Technology

Finance

Project management

Master of Arts in Education Check here ( )

Master of Arts in Teaching

Check here ( )

English Proficiency

Is English your native language? Yes No If “No,” what is your native language?


Telugu

What is your TOEFL or IELTS score? 6.5 Date taken: 2013

How many years have you studied English?

**Submit official TOEFL or IELTS score report with application**

Personal Essay Mission & Vision: In partnership with the Church, the purpose of William Jessup University is to educate transformational leaders for the glory of God. The William Jessup University vision is that our graduates will be transformed and will help redeem world culture by providing notable servant leadership; by enriching family, church and community life; and by serving with distinction in their chosen career.

Optional: If you would like to enhance our understanding of you, please feel free to tell us more about yourself. For example, previous applicants have written about the benefits that they expect to gain from attending a Christian university, particularly William Jessup University, and how those benefits fit into their personal goals in life. Thank you!

**Submit Personal Essay with application**

P. Shiva

Signature of Applicant: Date: 5/14/2018

Health & Medical

All international students are required to have health insurance before they are allowed to register for classes. You must either purchase health insurance with the assistance of our International Student Services office or provide proof of health insurance (that covers you while you are in the U.S.) at the time of registration.

Do you have health insurance? Yes No

If “Yes,” what is the name of the insurance company? . What is the policy number?

What are dates of coverage? (start & end dates)

STUDENT STATEMENT OF HEALTH (To be completed by Applicant)

Your application can only be processed after you have completed this form and the medical examination is completed by a physician.

Name: Panditaradhyula Shiva Male Female

Address: 500 Amalfi Loop, Apt-124, Milpitas, CA, 95035, USA (Number) (Street) (City/Town) (Country)

Date of Birth: 09 / 27 / 1989

(Month) (Day) (Year)

  1. Have you ever had any of the following conditions listed below? Yes No

Frequent Headaches, Hearing Difficulty, Rheumatism/Rheumatic Fever, Heart Disease, Lung Disease, Digestive/Stomach Pain, Frequent Abdominal Pain, Operation/Severe Injuries, Hernia, Arthritis, Frequent Dizziness/Fainting, Epilepsy/Seizures, High Blood Pressure, Kidney Disease, Nervousness or other condition.

  • If “Yes,” list the condition(s) on a separate page and give an approximate date for each condition you have had.
  1. To the best of your knowledge, are you now in good physical and mental health? Yes No

  • If “No,” give specific name of the disorder on a separate page and explain the current treatment.

MEDICAL EXAMINATION

Request that a physician complete the attached Medical Examination form. The form must be signed and dated by the physician. (An additional medical examination may be required prior to enrollment)

**Submit completed Medical Examination form with application**

Medical Examination

To be completed and signed by a Physician. Otherwise, applicant must provide an official Immunization Record. Dates must include month and year.

DESCRIPTION

YES

NO

ACTION

DATE

(month/year)

1. Tetanus-Diphtheria

(a) Completed primary series of tetanus-diphtheria immunizations.

(b) Received tetanus-diphtheria booster within the last 10 years.

2. M.M.R.

(Measles, Mumps, Rubella)

(a) Dose 1-Immunized at 12 months or after and before 5 years.

(b) Dose 2-Immunized at 5 years or later.

3. Measles (Rubella) if given instead of M.M.R.

(a) Had disease; confirmed by office record.

(b) Born before 1957 and therefore considered immune.

(c) Had report of immune titer. Specify date of titer.

(d) Immunized with vaccine at 12 months after birth or later.

4. Rubella, if given instead of M.M.R.

(a) Has report of immune titer. Specify date of titer.

(b) Immunized at 12 months after birth or later.

5. Mumps, if given instead of M.M.R.

(a) Had disease; confirmed by office record.

(b) Immunized with vaccine at 12 months after birth or later.

6. Tuberculosis: Check appropriate boxes. Give date and test results.

  1. PPD (Mantoux) test within the past year: Yes No Test Result: Positive Negative Date: (Note: Tine or monovac not acceptable)

  1. Positive PPD-Chest X-ray required: Yes No Test Result: Positive Negative Date:

  1. Had BCG vaccine: Yes No Test Result: Positive Negative Date: (Note: Chest X-ray required if PPD not done)

7. Polio

  1. Completed primary series of polio immunizations: Yes No

  1. Type of vaccine: Oral Inactivated E-IPV Date of last booster:

--------------------PHYSICIAN INFORMATION AND SIGNATURE--------------------

Name: Phone: Address: Signature: Date:

WILLIAM JESSUP UNIVERSITY

Supplemental International Graduate Student Admission Information

  1. I understand that I am required to attend the International Student Orientation held at the beginning of each semester.

  1. I understand that I must enroll in and complete a minimum of 9 units at the university each term with satisfactory grades or be subject to dismissal. Graduate students may enroll in a minimum of 6 hours in the MBA program in San Jose which requires a concurrent internship.
  1. I understand that I must obtain prior permission from the Registrar or International Student Counselor and the Director of International Programs Office (IPO) to enroll for less than 9 units or take a Leave of Absence and must provide documentation for any compelling reasons.

  1. I understand that I am required to purchase Health (Medical) Insurance, or provide proof of insurance, before being allowed to enroll in classes.

  1. I understand that, to remain in good standing, I must maintain a cumulative grade point average of

3.0 (B) or better for the Master’s programs. I am subject to academic dismissal if I remain on probation for two consecutive semesters.

  1. I understand that unmarried cohabitation, and/or any form of sexual misconduct, is considered unacceptable behavior for students enrolled at Jessup.

  1. I understand that students possessing, distributing, and/or using alcohol, narcotics, or other intoxicants, firearms, explosives or weapons (real or replicas) on Jessup premises or at University-sponsored activities will be subject to judicial action. William Jessup University reserves the right to confront behavior that is detrimental to the student, the community, the University, and/or others.

  1. I understand that smoking or chewing tobacco is not permissible while on campus at the University.

  1. I understand that in order to register each semester, I must pay my entire tuition before the beginning of each semester. I understand that there will be no deferment of payment, and that I must pay extra tuition and fees if I add courses after registration.

  1. I understand that I must notify the International Programs Office (IPO) of any changes in my status including, but not limited to, changing my address or phone number, transferring to another college, or returning to my home country permanently. Failure to do so will threaten my student status.

Your signature indicates that you have read and agree to all of the requirements listed above and that all information provided is complete and accurate to the best of your knowledge:

Student Signature: P. Shiva Date: 5/14/2018

Student Name (Please print): P.Shiva

WILLIAM JESSUP UNIVERSITY

Congratulations on taking the first steps to enrolling at WJU! We look forward to welcoming you into our community!

As required by federal law, this form is designed to verify your ability to pay for one year’s estimated costs for your studies, and related expenses, at WJU. This form, along with all required documentation, must be received by WJU prior to the issuance of your I-20.

Please keep the following points in mind when submitting financial documentation with this form:

  • All supporting financial documents/bank statements must be dated from within six months of the start of your academic program, and must contain the logo and/or seal of the bank, your (or your sponsor’s) full name, and the amount of funds available.

  • All bank statements and documents must be in English, or be officially translated into English. However, the amount of funds listed on statements may be in the currency of your home country, and does not need to be listed in U.S. Dollars.

  • Electronic versions of bank statements are acceptable, as long as they contain the issue date, the

logo and/or seal of the issuing bank, your (or your sponsor’s) full name, and the amount of funds available. While electronic bank statements are acceptable, “screen shots” of online banking sessions will not be accepted. Original documents are preferred, but high quality color scans sent via email may be accepted at the discretion of the Designated School Official reviewing your documents.

  • In lieu of bank statements, you may submit a letter from your bank (on official bank letterhead) containing the issue date, your (or your sponsor’s) full name, the length of the relationship with the financial institution, and the amount of funds available. Such letters must bear an official bank signature and bank seal.

  • Scholarship letters/financial guarantees must contain an issue date, your full name, and the date the scholarship goes into effect.

Real estate titles, investments/stocks, lines of credit, salary statements, and loans are not acceptable for the purposes of this form.

Declaration of Financial Support SECTION ONE: Personal Information

Name: Panditaradhyula Shiva

Date of Birth: 09/27/1989

Passport Number: J7196903

Passport Expiration Date: 08/17/2021

Permanent Home Country: INDIA

Address: 11-13-783/3, Flat Number:101, Sri Sai Nidhi Appts, Road Number:3, Green Hills Colony, HYD, INDIA

Country of Citizenship: INDIA

Intended Major: MBA

Starting Semester: May-2018

SECTION TWO: Estimated Expenses & Sources of Funding

Estimated Expenses per Year for the 2016-2017 Academic Year (in $US):

Graduate Semester

Tuition

$ 10,800

Student Fees

$ 760

Room and Board

$ 12,706*

Health Insurance

$ Provided by student

Books and Supplies

$ 1,804

Personal

$ Up to student

Total

$ 26,070

*Estimated Housing based on academic year. May be higher based on personal choice.

Your financial support can come from your personal funds, the funds of a sponsoring friend or family member, from government and or institutional scholarships, or from a combination of these sources. Your financial resources must meet or exceed the estimated totals listed above.

Declaration of Financial Support Please check/complete each section that applies to your sources of funding:
  • Personal funds (Amount in $US Dollars)$

I shall have sufficient funds available to pay all my necessary annual expenses in the amount indicated above this statement, and I shall further be able to pay for travel to and from my home country. I certify that the statements made on this form are true. Also, I understand that I shall not receive any need based financial aid from William Jessup University.

Signature: Date:
  • Funds from a Sponsor (Amount in $US Dollars): $ Sponsor’s Full Name: Relationship: Address: Phone: Email:

Please have sponsor read and affirm:

I hereby certify that I am able to provide the amount indicated above this statement annually to (student’s name): to meet all direct and related expenses incurred during his/her studies in the United States, should that person require access to those funds. I authorize the release of supporting financial documents and certify that the information contained within the supporting documents is accurate.

Sponsor signature: Date:

  • Government/Institutional Sponsorships (Amount in $US Dollars): $ Name of Sponsoring Institution:

Please provide a copy of your scholarship letter from the government agency or institution sponsoring your studies.

Declaration of Financial Support SECTION THREE: Required documents to send in with this form:
    • Proof of Financial Support from your (or your sponsor’s) bank, or government/scholarship letter.

    • If you are currently enrolled at another institution within the United States, please also include:

      • Photocopy of your current visa (stamped in your passport)

      • Photocopy of both sides of your I-94 (stapled in your passport)

      • Photocopy of Employment Authorization Document (if you are currently on CPT/OPT)

      • Photocopy of all I-20s issued to you at your previous institution

Please return this form and required documentation to:

William Jessup University

International Graduate Programs Office 2121 University Avenue

Rocklin, CA 95765

If you have any questions, please feel free to call the International Programs Office at 916-577-3220, or email at [email protected]