APPLICATION FORM

Personal InformationFirst name Last name Digital Picture

Nationality

Place of birth

Date of birth (mm /dd/ yy)

Age Sex M F Passport / ID Number

Home mailing address

Country Zip code

Home phone number

Student’s e-mail address

Student’s phone number

Emergency contact name

Email Phone

University of Origen

University Mailing Address (we will send your official transcript to this address, please confirm all the details before submitting this form)

Country Zip code

Phone number

Major

Academic Advisor’s Name and signature Academic Advisor’s Email

Academic Advisor’s Phone

School Term at ULACIT (specify dates)

APPLICATION FORM

Student’s signature: _______________________________ Date (mm/dd/yy):__________________

Advisor’s signature: ________________________________ Date (mm/dd/yy): __________________

Note: Please send this form thoroughly filled out to: vcastro@ulacit.ac.cr The information in this document may be verified at any moment during the enrollment process. Illegible forms will be sent back. We advise applicants to fill it out using Microsoft word and print it

only to be signed (this form is expected to be sent in PDF format). Please attach the following documents to this form:

Passport-sized digital picture Passport main page