Adelphi University

General English Application


Personal Details
As they appear on your passport



Birth Details
Date of Birth

DD

MM

YYYY



Passport Details
Date of Expiration

DD

MM

YYYY


Permanent non-US home address








Address in the United States






Please enter a valid 5 digit US Zip Code.
US Mobile Phone


Primary Home Phone



Primary Mobile Phone



Applicant's email address

Emergency Contact











Emergency Contact Home Telephone



Emergency Contact Mobile Telephone




Academic Details



*Not Available for Summer 

*Summer start only
**Semester start only

English Proficiency
Official exam results must be provided.

Date Taken or Scheduled

DD

MM

YYYY


Date Taken or Scheduled

DD

MM

YYYY

Date Taken or Scheduled

If you answered "Yes" to this question, please submit a copy of the English exam results with your application.


Disciplinary History
Please note that if new circumstances alter your status at the school or in your community after you submit this application, you are required to notify Adelphi University as soon as possible.






An affirmative response to any of the above questions will not automatically prevent admission, but any omission or falsification is grounds for denial, rescission of admission, or expulsion.

Form I-20

Select “Yes” only if you are currently studying on an F1 student visa in the United States, and have been issued an I-20 document from your current institution within the United States. If Yes or Yes - Expired, please provide a copy with your application materials.
I-20 End Date

DD

MM

YYYY
Dependents
Dependents are defined as spouses and/or unmarried children under 21.

Sponsored Students
Sponsored Students are defined as any students receiving a sponsorship from their local government, organization, or agency.




Medical Insurance Requirement

Additional Information






Declaration
NOTICE OF NON-DISCRIMINATION
Adelphi University is an equal opportunity educational institution and operates  without regard to race, sex, color, age, religion, national origin, disability or veteran status. The university complies with the regulations of Titles VI and VII of the Civil Rights Act of 1964, the Age Discrimination Act, the Age Discrimination in Employment Act, Title IX of the Education Amendments of 1972, Sections 503/504 of the Rehabilitation Act of 1973, the Vietnam Era Veterans Readjustment Assistance Act, the Americans with Disabilities Act of 1990, The Equal Pay Act and the Pregnancy Discrimination Act. Anyone wishing to file a complaint covered
by the above should go to the Affirmative Action Office in Suite 005 of the Quad Center, or call 844-4794 between 7:45 a.m. and 4:45 p.m., Monday through Friday.