University of California Berkeley Extension
Please read the school's information first,
then fill in this form. After you fill inthis form and press "Send" button, your information will
be submitted directly to schools. Hence, Please fill in this form in English precisely.
Date of birth
Address in home country
(include post code and country)
Telephone in home country
Fax in home country
Name of the Course
Check schools' data if unsure
Do you want assistance in obtaining accommodation?
What type of accommodation do you need?
Do you smoke?
Please list any special medical or dietary conditions you might have
Do you require airport pick-up and transfer?
(Answer the following questions if you knew your flight details)
International Student Details
English Language Proficiency
Please enter score or grade if you have taken any tests:
Is your verbal English
Is your written English
NOTE：The school reserves the right to vary fees, curriculum and timetables without prior notice.