|ELC APPLICATION FORM
||University of South Alabama
type the following information
Last (family name)
|Date of Birth _____/_____/_____ Country of Birth__________
Citizenship__________ Male___ Female___
||Spring 1 [ ]
||Spring 2 [ ]
||Summer [ ]
||Fall 1 [ ]
||Fall 2 [ ]
|Jan. - Feb.
||Mar. - May
||June - July
||Aug. - Oct.
||Oct. - Dec.
|Mailing Address (I-20 will be sent here)
Permanent Address in Home Country (if different)
|Telephone (___)___________________ Fax (___)__________________
|Have you graduated from high school? 0 Yes
How many years have you studied English? _____
|Have you ever applied to South Alabama's ELC program
before? 0 Yes 0 No
If yes, when? Month _____, Year _____
|Do you need an I-20 for an F-1 student visa?
0 Yes 0 No
|If you are now in the U.S., what kind of visa do you
have? 0 F-1, B-2, 0
J-1, 0 U.S. Resident
0 Other ______________
|What do you plan to do after studying English? 0 Study
at the University of South Alabama,
0 Return to home country, 0 Study at another
U.S. university or school, 0 other _____________
|How did you learn about ELC at the University of South
0 ELC Web site, O U.S. Information Service
0 Advertisement (please give the publication) _________________________________
0 Private Advising Agency (please give name) ____________________________________
0 Other ___________________________________________________________________
|In case of emergency, notify: (name, address,
phone number) ________________________________________
|IF YOU ARE TRANSFERRING from another U.S. school,
please give school name and address in the U.S.
phone number (___)______________________
|Signature of Applicant: I certify that the information
I have given is true and correct.
Applicants requesting an I-20 must provide evidence of
financial support for the period of study in
the U.S. While you are studying at the
University of South Alabama English Language Center,
your support will be provided by:
Personal funds [ ]
Funds from family in U.S.A. [ ]
Funds from family abroad [ ]
the accompanying Affidavit of Financial Support. An I-20 cannot be issued
without a financial
Because of the high cost of health care in the
United States, all students are required to purchase
health insurance from the University.
Students who wish to live in a residence hall
(dormitory) on campus can apply for a dormitory room after
they arrive in Mobile.
|PAYMENT PROCEDURE/REFUND POLICY
Tuition and fees are paid during registration.
Personal checks, cash, cashier's checks, bank checks,
and Visa/MasterCard are accepted. NO REFUND
IS GIVEN AFTER CLASSES BEGIN.
- Print this form. Fill out this application form,
and be sure to sign and date it.
- Send a non-refundable application fee of $50.
It should be a U.S. affiliate bank check or
money order made payable to the UNIVERSITY OF SOUTH ALABAMA in U.S. funds.
- The person responsible for payment MUST
a) Complete and sign the Affidavit of
b) Send a letter of financial guarantee
confirming that he/she has the funds necessary to pay all the living and tuition
expenses in the U.S.
- If you are a transfer
student from a U.S. university, an official from your current institution
must fill out our Transfer Eligibility Form.
- Please submit a passport-size photo with your application.
SEND TO: English Language Center,
University of South Alabama
Alpha Hall East #221
Mobile, Alabama 36688-0002 U.S.A.
Telephone: (251) 460-7185, Fax: (251) 460-7201
|Credit card payment: FAX ONLY if you complete
To pay the application fee and housing
deposit with MasterCard or Visa, complete this information:
_____ Only necessary for rush delivery of
I-20. Amount depends on country.
Account number __________-__________-__________-__________
Cardholder's name (Please print) _________________________________________________
Signature of authorized cardholder ________________________________________________
FOR SAFETY, FAX TO ENGLISH LANGUAGE CENTER
AT (251) 460-7201
DO NOT SEND THIS FORM THROUGH THE MAIL
OR THE INTERNET