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Questionnaire....

	PLEASE TELL US ABOUT YOURSELF
Preferred Entry Session:
Last Name:
First Name:
Date of Birth:	dd/mm/yyyy
Nationality:
Gender:	Female Male
Address:
City:
Postal code:
Country:	Please Select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France France, Metropolitan, French Guiana French Polynesia French Southern Territories <�/option> Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, The Former Yugoslav Republic of, Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of, Moldova, Republic of, Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Quebec Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis � Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China, Tajikistan Tanzania, United Republic of, Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands United States of America Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zaire Zambia Zimbabwe
Phone:
Fax:
E-Mail: Required
Current School or University:
Current year of study:
School/University  Name and Address:
School/University Telephone:
School/University Fax:
High School Students specify the curriculum you are following University Students list the courses you are taking (This year)
Father's name  and occupation: Diploma,University:
Mother's name  and occupation: Diploma,University:
Age and name of the other children in your family
Have you had contact with any graduate of an American college or university?	Yes No
If yes, give us his/her name and address:
For Foreign Students: Are there any American citizens in your family?	Yes No
If yes, give us his/her name and address:
How did you learn about AUAP?	Referral by Existing Student Search Engines Following a Link Telephone Book Newspaper Article Business Exchange Word of Mouth Brochure Lectures Chamber of Commerce Other
Name of AUAP Representative(s) who have contacted you:
ADDITIONAL COMMENTS
	YOUR PERSONAL PREFERENCES Please mark with Unacceptable, Acceptable or Desirable what best expresses your taste. You may skip questions if desired.
I. Type	University / College
Undergraduate (after secondary school)	Acceptable
Graduate School Masters degree	Acceptable
Graduate School Doctorate or Terminal degree (Ph.D., Ed.D., Psy.D.)	Acceptable
Public	Unacceptable   Acceptable   Desirable
Private (Harvard, MIT, etc.)	Unacceptable   Acceptable   Desirable
Religious	Unacceptable   Acceptable   Desirable
Coeducation (both sexes)	Unacceptable   Acceptable   Desirable
Single Sex	Unacceptable   Acceptable   Desirable
II.	University Environment
A. Urban (large metropolitan area)	Unacceptable   Acceptable   Desirable
B. City	Unacceptable   Acceptable   Desirable
C. Suburban (close to a city)	Unacceptable   Acceptable   Desirable
D. Rural (small town or far from a city)	Unacceptable   Acceptable   Desirable
III.	University Size
A. Small (less than 1,500 students)	Unacceptable   Acceptable   Desirable
B. Mid size (1,501 - 4,000)	Unacceptable   Acceptable   Desirable
C. Large (4,001 - 10,000)	Unacceptable   Acceptable   Desirable
D. Very large (10,000+)	Unacceptable   Acceptable   Desirable
IV.	University Lodging
A. On campus	Unacceptable   Acceptable   Desirable
B. Apartment, etc. off campus	Unacceptable   Acceptable   Desirable
V.	Yearly Budget Include all costs - tuition, meals, lodging and all mandatory fees. Financial aid is sometimes available for international students. Indicate the maximum yearly amount available from your family.
A. Less than $10,000/year
B. $10,001 - $15,000
C. $15,001 - $20,000
D. $20,001+
Total income of your parents last year:
VI.	Preferred Location
A. New England (Northeast)	Unacceptable   Acceptable   Desirable
B. Atlantic States	Unacceptable   Acceptable   Desirable
C. South	Unacceptable   Acceptable   Desirable
D. West	Unacceptable   Acceptable   Desirable
E. Northwest	Unacceptable   Acceptable   Desirable
F. Midwest	Unacceptable   Acceptable   Desirable
VII.	Religious affinity (if important)
Religion	Catholic Jewish Protestant Muslim Buddhism Greek Orthodox Russian Orthodox Other
Other	(Please specify if important to you)
I would like to be with students sharing the same religion:	Yes No No Preference
VIII.	Sports Here is a list of sports common at American universities. Tell us which ones you already participate in at the competition or leisure level
American Football Archery Badminton Baseball Basketball Bowling Crew Cross Country Running Equestrian Fencing Field Hockey Golf Gymnastics Ice Hockey Lacrosse Riflery Rugby Sailing Skiing Soccer Softball Squash Swimming and Diving Table Tennis Tennis Track and Field Volleyball Water Polo Weight Lifting Wrestling
I compete in the following sport:	(Specify the level as it may be important for undergraduate scholarship possibilities)
I would like to practice the following sport for my leisure:
IX.	Activities American universites have abundant cultural and associative activities. Please indicate your preference.
	Choral Dance Debate Drama Fraternities Honor societies Magazine Newspaper Orchestra Political groups Radio / TV Religion Service clubs Student Govt. Yearbook
I would like to participate in the following activities:
X.	Future Career
Indicate your career goals in order of preference:	1. 2. 3.
XI.	Favored Majors or Graduate Degree
Degrees:	1. 2.
XII.	Favored University
Name of University:	Please let us know if you already have a university in mind. (We will advise you if it is suitable)
XIII.	Extracurricular activities or work experience (that is relevant to your application)
Experience:	Please list your activities such as sports, community or civic involvement, art, leadership, elective post, clubs or societies. Also list all honors and diplomas you have received.
XIV.	Personal Essay (Optional)
Essay:	Write a brief essay about who you are, your personality and your career goals. This helps us to assess the best choices.
XV.	Tests
Tests:	Various tests are required as part of the admissions process to American universities. Have you taken, or are you registered to take, any American tests (i.e., TOEFL, SAT, SMAT, GRE, etc.)? If so, please list the test, test date and scores.
XVI.	Referral
Referrals:	1. 2. 3. Please send us the names and addresses of three persons who may be interested in the services of AUAP. Thank you!
XVII.	Academic Profile
	In order to match you to the best universities, we need to understand your academic performance. Please write about your transcripts/exam results and subjects or send us a copy my normal mail/post or write this out on a separate email. (All American universities will require official transcripts at time of application.) Please include subjects, rank in class, grades, specializations, etc.
Subscription	Yes, I want to subscribe to the following program(s):
	SELECTION PROGRAM       $350 for 4 universities FULL SERVICE GUARANTEED ADMISSION PROGRAM       (includes payment of test & applications fees)       $2500 for 4 universities ENGLISH LANGUAGE PROGRAM       $350 ADMISSION PROGRAM ADD-ONS ADDITIONAL UNIVERSITY       $300 USD per university RUSH SERVICE       $100 USD per university CONTINUING SUPPORT       $100 USD per hour
Payment $2500	Bank Draft in US Dollars       Payable to American Universities Admission Program (AUAP) Wire Transfer       Contact AUAP for wiring information

Download this questionnaire as TXT file for easy printing and faxing HERE

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AUAP American Universities Admission Program
5053 Ocean Blvd., Suite 19 - Sarasota FL 34242 -USA
Tel: (1) 941 346 1427 - Fax (1) 941 349 43 70 - e-mail: auap@auap.com

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