University of South Dakota - Graduate School

English Proficiency Exam Waiver

Complete and submit this form along with all supporting documents to Graduate Admissions at grad.docs@usd.edu or to USD Graduate Admissions, McKusick Technology Center,
Room 211, 414 E. Clark Street, Vermillion, SD 57069.

Biographical Information:
Name on Passport | Surname: _______________________________ Given Name: _______________________________________
Other name(s), if any, that may appear on academic records: ______________________________________________________________
Date of Birth (MM/DD/YYYY): _____________________________________________ Email: ___________________________________________
Current Country of Residence: ___________________________________________ Country of Birth: ____________________________________
Program of Interest: ___________________________________________________ Term: ___________________________________________

Educational History:
High School / Higher Secondary Education
Country of Education Curriculum Followed Language of Instruction Graduation Date

Post-Secondary Education
Country of Education Institution Attended Language of Instruction Degree Granted Conferral Date

Additional Information:
Please indicate dates and scores for any of the exams you have taken. TOEFL Date:_____________ Score:______________
Be sure and attach additional information to support your waiver
request, including transcripts, copy of passport, professional IELTS Date:_____________ Score:______________
examinations or proficiency certifications you have received. PTE Date:_____________ Score:______________
SUPPORTING MATERIALS:

Office Use Only:

Education USA supported: Yes No
Reason for Decision:
Request Decision: Approved Denied Student ID#: ________________

_______________________________________ ________________
Dean of Graduate School Signature Date

414 E. Clark Street • Vermillion, SD 57069 • 605-658-6200 • Fax: 605-677-6118 • www.usd.edu/grad • grad.docs@usd.edu
Revised, 10/1/19