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Teodoro Obama / 26548000 / [1454301]

APPLICATION FOR ADMISSION
APPLIGATION FOR:Online Class Start Date: Campus

Location:

American InterContinental University Online 231 N. Martingale Road, 6th Floor Schaumburg, lL 60173

Admissions

Advisor:

JessicaSherman

Are you interested in applying for Financial

Aid? fl Yes

E

No

PERSONAL DATA
First (Given)

Name

Last (Family)

Name

Middle lnitial
SSN #:

Applicant's FullLegal

Name: Teodoro
State:

Obama

Home Address:4655 pomarine circle

City: norcross
Work Address:
City:

GA

Country: US

Postal Code: 30092

State:
Work Phone:Country:

Postal Code: Fax:

Home Phone: 6787023895 What is the best time of day to reach you? Primary Email: teodoroobama@hotmail.com
U.S.

Secondary Email:

Citizen?

ls EnglishE Yes E No Legal Permanent Resident? E yes your first language? E Yes EI ruo
03/16/1S90

E

No

lf English is not your first language, have you taken a TOEFL Exam or EnglishProficiency
Date of

Exam? E Yes

E

tto

Birth:

E Ho Have you ever been convicted of a criminal offense (other than minor trafiic offenses)? E Yes E
Do you have regular and reliableaccess to a computer and the

intemet?

E Yes

ruo

lf yes, please

describe:

Do you have any family members or friends who are alumni of American lnterContinental University?lf so, please name.

Optional

Gender:

E ttate E Female Ethnicity:

Demqraphic queslio,?s are used for instifutional reearch purm,ses only and not in the application p,o@ssAmerican lntercontindttal University Online 231 N. Martingale Road, 6th Floor' Schaumburg, lL 60173 * Telil-877-701-3800 * www.aiuonline.edu
Application For Admission Eff. 5/30/11