SECTION A: ABOUT YOU
Name of agency/person referring you to ELI :
* First Name :
* Last Name :
* Home Address :
Home Postal code
-
Home Telephone :
-
-
* Birthday :
* Gender :
Male
Female
Local Address in USA
(if available) :
Local Telephone :
-
-
* Nationality :
* Email:
Your Plan
* First day of class :
/
/
Expected last day of class :
/
/
* How long will you study at ELI?
month, or
weeks
* Do you need an I-20?
(If yes, please complete Section C )
(What is this?) :
Yes
No
Choose your program type
(What is this?) :
English as a Second Language Program
TOEFL Test Preparation Program
Do you need airport transfer? ($ 80) :
Yes
No
* What is your English Language skill level?
Good
Fair
Beginner
* ENROLLMENT AGREEMENT (4 weeks - PDF)
Click
to read
I have read and agreed to the enrollment
agreement
SECTION B: HOUSING REQUEST
Do you need housing arrangements?
Yes
No
Please choose what kind of housing you need:
Homestay
Residence Hotel
When will you need housing?
-
Homestay Preferences
Are you allergic to any foods?
Yes
No
If yes,
what types?
Are you allergic to any animals?
Yes
No
Is a host family with children okay?
Yes
No
Do you smoke cigarettes?
Smoke inside
Willing to smoke out side
Non smoker
Residence Hotel Preferences
Do you want a private or shared room?
Private
Shared
Do you want a private or shared bathroom?
Private
Shared
SECTION C: FINANCIAL INFORMATION
Estimated amount of money available in my personal bank account:
OR I will be sponsored by my family. Estimated amount of money available in my sponsor’s bank account:
To submit your application, please enter the following characters to confirm your information: