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| For University of California, Irvine students ONLY |
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This form can only be accessed using Internet Explorer on a PC. Use the TAB key to navigate through the fields. If you make a mistake you may go back, correct your information, and re-submit it.
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| Student ID: |
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| Last Name: |
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| First Name: |
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| Preferred Name: |
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| Sex: |
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| Street Address: |
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| City: |
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| State: |
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| Zip: |
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| Local Phone: |
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| Work Phone: |
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| Cell/Pager: |
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| UCI E-mail Address: |
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NOTE: E-mail is the primary method of communication between CIE and UCI students. CIE requires all EAP and IOP applicants to have and regularly read their UCI e-mail account. Without it, you will miss crucial information! Make sure CIE e-mail does not filter to your Junk Mail Folder.
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| Class Level: |
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| Graduation Date (best estimate): |
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Cumulative UCI or Transfer GPA
(incoming freshmen enter '0'): |
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| Major: |
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| Second Major (if applicable): |
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| What brought you to CIE and/or the CIE Web site today? (check 1-3 primary reasons): |
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| Type(s) of experience in which you are interested (check all that apply): |
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| Length of experience in which you are interested (check all that apply): |
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| Geographic areas of interest (select all that apply): |
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| Region 1: |
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| Region 2: |
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| Region 3: |
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| Do you have a specific country in mind? |
| Country 1: |
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| Country 2: |
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| Country 3: |
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| Do you have a specific international program in mind? No Yes |
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| Are you currently receiving financial aid at UCI? No Yes |
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