ISS Admission Application

Please provide us with the following information so that we can begin processing your application.

Note: This application is for international students only.

Personal Information

*Family/Last Name:
*First Name:
Middle Initial:
*Father's Name:
*Mother's Name:
*Birth Date:
*Country/City of Birth:
*Country of Citizenship:
*Gender:
MaleFemale
*Marital Status:
SingleMarriedDivorcedOther

Contact Information

*E-mail Address:
*Home Country Mailing Address:
*Home City:
*Home State or Country:
*Home Postal Code:
Home Country Phone #:
Local (U.S.) Address:
Local City:
Local State:
Local Zip Code:
Local Phone #:

Admission Status

*Admission Type:
New FreshmanTransfer Student
*Semester Applying For:
Spring 2015Summer 2015Fall 2015Spring 2016Summer 2016Fall 2016
*Desired Degree:
Bachelor of ScienceAssociate of ArtAssociate of Science
*Proposed Area of Study (Major):

Educational Background

*Secondary School:
*Graduation Date:
*Post Secondary Education:

Acceptance of Terms

I certify that the above information provided in this application is true and correct to the best of my knowledge. I also declare that if I attend Dixie State University I will abide by the academic, scholastic, and social standards of the university. A student found guilty of nondisclosure or misrepresentation in filling out this application form will be subject to disciplinary action and dismissal from the university.

*Do you accept the terms?
I accept

Optional Information

How did you hear about Dixie State University?
*Agency Affiliation:

Please click the submit button when complete:

*Indicates Required Information
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