Please complete and return this International Supplement as part of a complete International Student Application for Admission to Willamette University.

Full legal name as it appears on your passport:

___________________________________________________

Which is your family name/surname?______________________________

Country of citizenship:__________________________________________

Birthplace:____________________________________________________

Passport number:_______________________________________________

Please verify the mailing address to be used for all admission correspondence:
_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

I - plan - do not plan to bring dependents with me (check one).

Name of Spouse: _______________________________________________

Number of Dependent Children: __________________________________

I understand that I must submit a photocopy of the photo identification page of my passport and a completed Financial Guarantee
Statement, in addition to the required academic credentials, essays, and recommendation, as part of a complete application file and
that my application for admission will not be reviewed without these items.

Signature:_____________________________________________________

Today’s Date:__________________________________________________