Application for Admission

Section 1 (all applicants). Please provide the following information.

Previous Surname (if applicable)

Date of Birth (month/day/year)
example: 02/27/69

State/Country of Birth

Gender
Select One Female Male

Citizenship
Select One U.S. Other

United States Social Security Number
example: 201-92-3094

Ethnicity
The U.S. Department of Education requires that the University report on the racial composition of its student body. Self-identification by race is completely voluntary, and racial information on individual students is held in strict confidence by the University and Continuing Education and Special Programs.
Select Ethnicity Asian (please specify in field below) Black Hispanic (please specify in field below) Native American (Indian, Eskimo, Aleut) White Other (please specify in field below)

If you marked Asian, Hispanic, or Other above, please specify your nation of origin.

Have you ever applied to or enrolled in any division of Columbia University?
Select One Yes (please specify in field below) No

If you answered "yes," which division and when?

Have you ever been suspended or dismissed from another college?
Select One Yes (please send a separate letter of explanation) No

School Mailing Address

Present Address Line 1

Daytime Telephone
( ) - ext.

Evening Telephone
() - ext.

E-mail Address

Permanent Address (if different from above)

Permanent Address Line 1

Permanent Address Line 2

City

State, Province, or Territory

Zip Code

Country
Select One United States Other Unlisted Country Afghanistan Afghanistan Albania Algeria Andorra Angola Antigua And Barbuda Argentina Armenia Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Botswana Br. Virgin Islands Brazil Brit. West Indies Brunei Bulgaria Burkina Faso Burma Burundi Byelarus Cambodia Cameroon Canada Cape Verde Repub. Cayman Islands Cent African Rep. Chad Chile Colombia Comoros Congo Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Gaza Strip Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kampuchea Kazakhstan Kenya Kiribati Islands Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malagasy Republic Malawi Malaysia Maldives Mali Malta Mariana Islands Martinique Mauritania Mauritius Mexico Midway Islands Moldova Monaco Mongolia Morocco Mozambique Namibia Naura Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria North Korea Northern Ireland Norway Oman Other Unlisted Country Pakistan Panama Papua New Guinea Paraguay People's Republic Of China Peru Philippines Poland Portugal Qatar Romania Russia Rwanda San Marino Sao And Principe Saudi Arabia Scotland Senegal Seychelles Sierra Leone Sikkim Singapore Slovak Republic Slovenia Solomon Isles Somalia South Africa South Korea Soviet Union Spain Sri Lanka St Pierre and Miquelon St. Christopher-Nevis St. Lucia St. Vincent-Grenadines Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wales Western Samoa Yemen Yugoslavia Zaire Zambia Zimbabwe

Daytime Telephone
() - ext.

Evening Telephone
() - ext.

Person to contact in case of emergency:

Address Line 1

Address Line 2

City

State, Province, or Territory

Zip Code

Daytime Telephone
() - ext.

Evening Telephone
() - ext.

E-mail Address

How did you hear about the program?

Section 2 (all applicants). Please indicate the program and term for which you are applying.

Select Program Summer Language Program in Beijing Berlin Consortium for German Studies Summer Program in Scandiano, Italy Select Term Spring 2001 Summer 2001 Fall 2001 Academic Year 2001-2002

Section 3 (all applicants). Please provide your educational background below.

Please list the name, place, dates, type of diploma or degree, and date transcript ordered (if applicable) for each school you have attended, beginning with high school.

Example: Central High School, Hartford, CT, 9/93-6/97, diploma, 3/13/99

Section 4 (Berlin applicants only). Please provide the following information.

Please indicate your home school.
Select One Barnard College Columbia College School of General Studies Visiting Student from other school (please specify below)

If you marked "Visiting Student from other school," please specify your home college or university.

Note: if you are a student from the University of Chicago, Johns Hopkins University, University of Pennsylvania, Princeton University, or Yale University, you must turn in your application in hard copy to the appropriate office at your school.

Personal Statement: please write a brief (200-300 word) statement in German explaining why you wish to attend the Berlin Consortium for German Studies. Please include your full name, phone number, and e-mail address, and indicate that you are submitting your application online. You may submit your statement by fax (212-854-7400) or by e-mail ([email protected]).

Recommendations: please indicate the two individuals--dean and German language faculty member--whom you have asked to submit recommendations on your behalf to the Berlin Consortium Office in New York.

Official Transcript: please indicate the date on which you requested that the registrar of your school send an official transcript to the Berlin Consortium Office in New York.
example: 02/27/97

Do you give permission to release your name, address, and telephone number to students accepted into the Berlin Consortium for German Studies? Select One Release Do not release

Approvals: if Consortium courses are to be credited to your home college major, please arrange for your major adviser and your dean of students/study abroad adviser to contact the Berlin Consortium Office in New York.

Do you know of any health problems--physical or psychological--that could be expected to cause you difficulties while studying in Berlin? [Please note that such a medical situation will have no bearing on your application.] Select One Yes (see below) No

If you answered "yes" to this question, please write a separate letter to the Berlin Consortium Office in New York with the appropriate medical information.

Visiting Students: an official transcript will be sent to your home college when your grades have been received in New York. Please give the precise address to which that transcript should be sent.

Name of Institution

Address

City

State, Province, or Territory

Zip Code

Select here to advance to your next section.

Section 5 (Beijing applicants only). Please fill in the appropriate information below.

Mailing Address After May 15

Street Address

City

State, Province, or Territory
Select One-For U.S. and Canadian Addresses Only Alabama Alaska Alberta American Samoa Arizona Arkansas British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territory Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Island Virginia Washington West Virginia Wisconsin Wyoming Yukon

Zip Code

Country

Chinese Name (if any)

Chinese Language Information

If you are a Columbia or Barnard student, please list your Chinese teachers by semester:

Length of Mandarin study at college level or equivalent by end of this academic year (please specify by months, semesters, academic years, or other explanation):

Chinese character forms you are familiar with:
Select one simplified traditional both neither

Phonetic system you are familiar with:
Select one Pinyin BPMF (Taiwan) both neither

Please list the textbooks you have studied:

For placement purposes only, please tell us about your Mandarin proficiency level in speaking. Specify whether you are able to speak words and phrases, sentences, extended paragraphs, or another level (please explain).
Select one words and phrases sentences extended paragraphs other (please specify below)

If you selected "other," please explain:

For placement purposes only, please tell us about your Mandarin proficiency level in listening. Specify whether you are able to understand simple words, short simple sentences, conversations with limited vocabulary, or another level (please explain).
Select one simple words short simple sentences conversations with limited vocabulary other (please specify below)

If you selected "other," please explain:

Please specify the Mandarin level you wish to enter.
Select one level 1 (advanced beginner) level 2 (intermediate) level 3 (advanced) level 4 (advanced reading)

Housing

I prefer to live:
Select one with a host family in a dormitory

Section 6 (Scandiano applicants only). Please fill in the appropriate information below.

Indicate the course you wish to take.

Select one Italian S1203O. Intensive intermediate Italian Italian S3650O. Italian theatre practicum Italian S4043O. Italian Renaissance literature and culture

Section 8 (all applicants). Please fill in the appropriate information below.

Release and Certification
By completing this application, you are acknowledging that you realize that my name and home school will be shared with other program participants. (If you do not wish this to happen, please send a separate letter in writing to the Office of Overseas Programs, Columbia University, 203 Lewisohn Hall, Mail Code 4119, 2970 Broadway, New York, NY 10027-6902.)

Transcript
An official transcript will be sent to your home college when your grades have been received in New York. Please give the precise address to which that transcript should be sent.

Name of Person

Name of Institution

Address Line 1

Address Line 2

City

State, Province, or Territory

Zip Code

How did you hear about the program to which you are applying?

Do you certify that the information on this application is complete and accurate?
Select One Yes No

Students not enrolled in any school or division of Columbia University must pay the nonrefundable $35 application fee. Note: your application will not be processed without your application or enrollment fee.

You may pay your application or enrollment fee either by sending a check, payable to Columbia University, or by filling in the appropriate credit card information below.

Select your payment method:
Select One check credit card

Please charge to:
Select One MasterCard VISA

Card Number
Exp. Date:
Cardholder's Name

Please include any additional comments or questions in the box below.

You may submit your application now. Please make sure that you have read the application instructions for your particular program, and that you have made arrangements to send any required materials (including transcripts) and fees.
Note: your application will not be processed until all materials and fees are received.