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APPLICATION FOR INTERNATIONAL DOCTORAL ADMISSION

Welcome to Concordia University Chicago! We look forward to receiving your application and to working with you
throughout the admission process.

All applicants should have an earned Bachelors and Masters Degree from a regionally accredited college or university.
Concordias graduate admission committee evaluates all credentials submitted by applicants on a rolling basis, to determine a
students ability to succeed in graduate school. Concordia admission representatives are committed to help, assist and expedite
the admission and enrollment process for you. Concordia University Chicago admits students without regard to age, sex, creed,
race, color, or national or ethnic origin.

If you have any questions or experience any problems as you complete your application, please contact us at
international.gus@CUChicago.edu.

Application Checklist
Completed and signed application
Submission of rationale statement, including personal goals for applying for admission to the program.
Writing Sample: Submit a paper from your masters program that demonstrates your ability to write in a scholarly
manner at a level typical of graduate work. This sample should approach, but not exceed, five pages in length.
Bachelor and Master Degree: Copy of Original Academic Transcripts and Diploma with Official English Translation
Copy of Passport
Current Graduate Record Exam (GRE) or Miller Analogies Test scores (test taken within the prior three years).
Professional Resume showing past experience: at least two years of successful teaching/administrative experience
Proof of English language, TOEFL, IELTS or equivalent
Declaration of Finances/Bank Statement

What degree do you intend to pursue at Concordia?

(Please choose only one below)

PhD Leadership: Curriculum and Instruction PhD Leadership: Early Childhood Education
PhD Leadership: Educational Leadership PhD Leadership: Organizational Leadership
PhD Leadership: Higher Education Specialization PhD Leadership: Reading, Language, and Literacy

Anticipated Start Date: Year _________

Planned Start: Spring I January Fall II October

What Delivery Mode would you like to study

100% on Campus

Blended Coursework on campus and dissertation at a distance

Do you plan to live on campus or off campus?*

On-campus residence hall

Off-campus housing

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*Important note: If an international student chooses to live off campus, they must provide acceptable proof of off-campus housing
arrangements. For an explanation of what constitutes acceptable proof of off-campus housing arrangements as well as for additional
information regarding on-campus dormitory and meal plan options and prices, please contact CISS@CUChicago.edu.
Personal Details

Last Name

First Name

Maiden/Former Name

Home street address

Apartment/Unit

City

State

Country

Zip Code

Home phone number

Cell phone number

Mailing Address (if different from above)

Home street address

Apartment/Unit

City

State

Country

Zip Code

Email

Gender Male Female

Date of Birth

Citizenship

Country of Birth

If you are not a U.S. citizen: Permanent Resident Number A- Visa Type ______________________

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ACADEMIC HISTORY (List all colleges and universities where a degree was earned with the most recent school first)
College/University Name Location Dates Attended Degree Earned

_ _______________________ __________________ _____________ ________

_ _______________________ __________________ _____________ ________
_ _______________________ __________________ _____________ _________
_ _______________________ __________________ _____________ _________

PROFESSIONAL EXPERIENCE
Employer Location Dates Employed Job Title
_ _______________________ __________________ _____________ ___________
_ _______________________ __________________ _____________ ___________
_ _______________________ __________________ _____________ ___________
_ _______________________ __________________ _____________ ___________
Do you hold a valid teaching certificate? Yes No

Have you attended Concordia University Chicago before? Yes (indicate year) _ _____ No

OBJECTIVE STATEMENT
Provide information on your future educational goals and their relationship to pursuing graduate work at Concordia University.
This short essay is an essential part of the admission process (please submit a typed essay on a separate sheet, no longer than
one page in length).

Race/Ethnicity
CUC values diversity, faith, and mutual trust in order to foster diverse experiences, cultures and skills. Please help us to continue our work
by providing information on inclusion and diversity. We will use the information below to review our activities and services for improvement,
and to consider what we may need to do to meet the needs of our diverse student body. While completion of this section is optional we do
hope that you will provide us with the information to assist us with our mission to be a university that is accessible to everyone. Thank you.

Marital status: Single / Never Married Divorced Widowed Married Separated (Legally)

Religious Affiliation (optional): __ __________________________________

Do you have any relatives who attend(ed) Concordia University Chicago (formerly Concordia University, River Forest)? Yes No

If yes, what relation? __ __________

Are you Hispanic or Latino? If yes select one:

Cuban Mexican Puerto Rican Other Hispanic

Are you (select one or more):

American Indian or Alaskan Native Black or African American
Native Hawaiian and Other Pacific Islander Asian

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 White

TERMS AND CONDITIONS

The terms and conditions provided in this application summarize certain student related practices and policies. This is not
intended to be a complete description of all Concordia University student policies and procedures, nor is it intended to represent
all potential costs and fees. For the complete, official list of Graduate student practices, policies, costs and fees, please refer to
the Concordia University Graduate Catalog. This catalog can be found by search Graduate Catalog at www.CUChicago.edu.

Seminar In Higher Education

International students pursuing a doctoral degree at Concordia University Chicago are required to take the Seminar in Higher
Education in addition to the courses required for their degree program. The Seminar is a 3-credit course taken during the
students first term of their semester as an enrolled student. This course will serve as an introduction to the U.S. based higher
education learning environment. Students will work to develop academic language, graduate level study skills and gain
essential support with cultural and institutional acclimatization.

Graduate Financial Policies

Concordia University Chicago accepts all fees with the understanding the student, by being assessed such fees, agrees to abide
by all the regulations of the University, whether printed in this application form or not, and by any appropriate decisions of the
administration or faculty regarding the students status in the University. Although the University exercises reasonable
precautions, it can assume no responsibility for accidents to students that may occur, incident to, by attendance at, or
participation in classroom or laboratory work, intramural activities or other University programs and activities. Also, the
University does not accept responsibility for any personal property lost, stolen, damaged or misplaced.

By registering for courses, students acknowledge that they are required to pay all applicable tuition and fee charges.
Email is the Universitys primary source of communication. A statement of the account balance will be emailed to the students
Concordia-Chicago email address each month after the start of the semester, if the tuition account has a verified outstanding
balance. Payment will be expected at the appropriate due date.

Tuition
Contact International.gus@CUChicago.edu for availability and pricing of all graduate programs. Payments must be made to the
Concordia University Chicago Graduate Admission and Student Services by the published deadlines for payments. Failure to
meet published deadlines may result in non-registration for that term/session or in future terms/sessions.

CUCs Tuition Guarantee

As long as there are no interruptions in your course of study, Concordia University Chicago guarantees that your tuition will
remain the same and never increase while earning this degree.
Pre-arrival Deposits
Prior to arriving into the United States, all international students are required to make two deposits in order to secure their place
at Concordia University Chicago. These deposits will be credited towards your tuition and fees at the time of registration.
These deposits are
1) $300 I-20 Deposit
2) $4,200 Enrollment Deposit

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These deposits signify a serious commitment to attend Concordia University Chicago and therefore are non-
refundable for all cases except for student visa denial.

Method of Payment
Payments may be made in person, over the telephone, or online at CUChicago.peertransfer.com. Payments made in
person may be made via cash, money order, personal check or credit card (at no additional charge). Payments made over the
telephone must be made via credit card. All such credit card payments taken over the telephone shall be subject to a 2.75
percent convenience fee to be added to the total amount of the payment.

Payments mailed directly to the University must be in the form of personal check or money order. Please visit
CUChicago.peertransfer.com for additional information regarding online payments. For more information, please contact
our Graduate Admission and Student Services at International.gus@cuchicago.edu. All fees, whether paid by a person or an
organization, shall be paid in United States dollars. MasterCard, American Express and Discover Card will be accepted for any
payments, whether in person, over the telephone, online or through the monthly tuition payment plan.

Students with Outstanding Balances

Students with outstanding balances shall not be allowed to participate in commencement ceremonies and are not entitled to
receive a diploma, transcripts, credentials or verification of education until balance is paid in full with guaranteed funds and is
verified by the Director of Student Business Services. Any account with an outstanding balance will be subject to a 1.5 percent
or minimum $25 service charge, each month on the account, until paid in full.

Concordia University Chicago retains the right to drop a students classes at any time in the event the student fails to meet
payment deadlines. Having classes dropped will likely result in a student becoming ineligible to hold an active F-1 or J-1 Visa.

Any person with an outstanding balance shall not be entitled to receive a diploma, transcript, or credential certification until
payment is made in full with certified funds and verified by the Director of Student Business Services.

Collection Policy
If an outstanding balance remains on the student account after a term has ended, the student is no longer an enrolled student.
At this point, the student is considered to be a collection account. Students considered to be a collection account will likely be
ineligible to hold an active F-1 or J-1 Visa.

Any efforts to collect the unpaid balance to Concordia University Chicago that are made by a third-party source are the students
responsibility. Such costs include, but are not limited to, fees from the outside collection agencies, attorney fees, court costs,
service charges, etc. This policy is governed by the laws of Illinois.

Course Drop Policy

It is the students responsibility to understand all consequences of dropping courses.

It needs to be understood that all international student must be full-time students in order maintain an active F-1 Visa status.
Dropping a course MAY result in a student being considered a part-time student. Prior to dropping any courses, students
should consider the impact on the F-1 or J-1 Visa status.

Concordia University Chicago has defined a specific course sequence for the Doctoral programs listed in this application. If a
student chooses to drop a course, that action may result in a student falling out of course sequencing. While Concordia
University Chicago will attempt to bring the student back in line with the defined course sequencing, it is possible that dropping
a course could result in a significant delay in the completion of a degree.

Course Refund Policy

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Dropping courses may result in a refund of tuition according the following refund schedule:
8-Week Courses (first or second half of term)
100% Refund through the end of the second week of class
67% Refund through the end of the third week of class

No refund after the third week of class

Refund policy does not apply to the I-20 or Enrollment Deposits, both of which are non-refundable for all cases accept for visa
denial.

Withdrawal from the University

Outstanding balances are due and payable in full upon withdrawing from Concordia University Chicago. Written notification of
the students withdrawal date must be submitted to the Office of Graduate Admission and Student Services no later than the last
intended class day of study.

Required Medical Insurance

As a condition of the F-1 or J-1 visa, the US government requires that all international students to have medical insurance while
they study in the US. The Health Insurance and Wellness Fee, which is charged to all students, provides insurance that meets
and exceeds the F-1 or J-1 visa requirements. Current price - $1,280 (8/1/16 7/30/17).

Required Immunizations
Illinois State law and CUC policy requires all International Students at Concordia University Chicago to provide written evidence
of current immune status, or evidence of exemption from this requirement, for the following communicable diseases:

Measles (Rubeola) Two dos es requi red a fter fi rs t bi rthda y.

German Measles ( Rubella) Two dos es requi red a fter fi rs t bi rthda y.

Mumps Two dos es requi red a fter fi rs t bi rthda y.

Tetanus/Diphtheria Tetanus a nd Di phtheri a most recent booster (mus t be a Tdap wi thi n l a s t 10 yea rs )

Menactra (Meningitis) One dos e a fter the a ge 16

Al l Interna tiona l Students a re REQUIRED to ha ve a Tubercul os i s Ski n Tes t wi thi n the l a s t

yea r. The tes t res ul t MUST BE NEGATIVE. If the res ul t i s pos i tive, s tudent mus t obtai n a
Tuberculosis-TB skin test
Ches t X-Ra y. A s tanda rd medi a l report from a n offi ci a l hos pi tal wi th Engl i s h tra ns l a tion i s
s uffi ci ent

Copies from your high school or doctor are acceptable with English translation and you may have those sent directly to us as
attachment to your immunization form.

The state law applies to all public and private colleges and universities in Illinois, and went into effect on July 1, 1989.
Students whose first enrollment at Concordia began in the fall 1989 quarter or later will be required to comply with the policy;
previously enrolled students and students born prior to January 1, 1957, are exempt from this requirement. Evidence of
immunization should be provided no later than the beginning of the students first term of enrollment at ConcordiaChicago.

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The University requires that each student also must submit results of a chest xray or other test for tuberculosis administered
within one year prior to entry. Failure to provide this documentation will result in the placing of encumbrances on the
students record, which will prevent further enrollment. For questions about immunizations please contact CISS@CUChicago.edu.

Food Service
Specific information regarding meal plans (both resident and commuter) can be found at CUChicagodining.com.

Other Required Fees

Technology Fee $15 per credit hour (not to exceed $195 per term)
Graduation Fee: $130 required of all students receiving a degree or a Certificate of Advanced Studies. Graduation fees are
assessed and payable one month prior to the graduation date. An additional cost for academic regalia is the responsibility of
those students participating in the graduation ceremony. For questions regarding tuition and fees please contact
international.gus@CUChicago.edu.

The Honor Pledge

As a student of Concordia University Chicago and a member of the larger society, I pledge to uphold an academic
honor code that supports serving and leading with strong personal integrity. Specifically this includes not cheating
or using inappropriate or dishonest means in the completion of academic requirements. This also includes not
giving unauthorized assistance to others. I understand that it is my responsibility to comply with this honor
system.

I understand that Concordia Universitys official policies and procedures mentioned above in the Terms and Conditions. I
understand and agree that these policies and procedures may be revised during my enrollment at Concordia University. I agree
that I am responsible for reviewing and abiding by these policies and procedures.

My signature on this application certifies that the information is, to the best of my knowledge, accurate, complete and my own. I
understand that the falsification or withholding of any information in regard to this application may result in my being refused
admission or a required withdrawal without refund or credit.

Signature of Applicant: _________________________________________Date: _ __________________