德州大学奥斯汀分校在线寒假课程开放报名.pdf

Application for Virtual International Academy January 9 – 20, 2023 Submit your complete application form to michelle.zhou@austin.utexas.edu. Contact us by email michelle.zhou@austin.utexas.edu or phone at 1‐512‐ 471‐2480 with any questions or concerns. 1.PERSONAL INFORMATION Please type or print your name exactly as it appears on your passport. Applicants must be at least 17 years of age. Last name (family name) Gender male First name (given name) female Date of Birth (month, day, year) Country of birth Country of citizenship Street address City Province Country Country code telephone number Postcode Email (required) 2.HOW DID YOU LEARN ABOUT THIS PROGRAM? IMPORTANT Sign below to authorize UT’s English Language Center to release your financial and academic records to the agent/representative listed.  Education agency  Embassy  University/partner institution  Other (relative, friend) Contact name Contact email 3.PROGRAM SELECTION □ Accounting Engineering Language & Culture Software Engineering Academic + English (60 hours) $1300 Academic +English (60 hours) $1300 Academic+English (60 hours) $1300 Academic + English (60 hours) $1300 4.STUDENT SIGNATURE I certify that the information on this entire form is correct to the best of my knowledge.