UL Lafayette: International Affairs: Intensive English Program Application

Intensive English Program Application

After the form is submitted, a staff member should receive it and reply within three (3) working days. If a reply isn't received within that time, please call (337) 482-6819 or e-mail oia@louisiana.edu.

First Name :

Family (Last) Name:

Home Address:

Number and Street or P. O. Box

City Country Postal/Zip Code

Telephone Number (country code/area code/number)

Fax Number (country code/area code/number)

Email address

Mailing Address:
(If different from above)

Number and Street or P. O. Box

City Country Postal/Zip Code

Date of Birth: (month/day/year)

Sex: Male Female

Country of Birth:

Country of Citizenship:

Did you finish high school? Yes No , If yes, which Year:

Have you taken a TOEFL test? Yes No , If yes, what was your score?

How long have you studied English?

What sessions do you wish to attend?

What will be your major after completing the IEP?

If you are requesting an F-1 visa and plan to bring your family with you, please list the information below:

Your Spouse name

Date of Birth: (month/day/year)

Country of Birth:

Your 1st Child name

Date of Birth: (month/day/year)

Country of Birth:

Your 2nd Child name

Date of Birth: (month/day/year)

Country of Birth:

If you are now in the United States, please answer the following questions:

On what date did you enter the United States? (Month/Day/Year)

What type of visa do you have?

*If you have a F-1 or J-1 visa, please enclose a copy of your I-20AB or DS-2019

Visa expiration date? (Month/Day./Year)

If available, U.S. Social Security Number:

Are you sponsored by a government or corporation? Yes No

If yes, do you have permission from your sponsor to transfer to our program? Yes No

Sponsor's Name:

Where/How did you hear about the IEP?

Will you require housing on-campus? Yes No
NOTE: Housing for married couples is not available.
Also, housing is on a first-come-first-serve basis.

I certify that the information I have provided is correct to the best of my knowledge
(Your Initials)

YOUR EMAIL:

REMINDER

Before we mail you an I-20A B make sure that you submit:

Your application
The application fee (US $35.00 non-refundable)
The tuition deposit (US $150.00 non-refundable)
Housing deposit (US $100.00 non-refundable)
An original translation of your official or certified true copy of your high school transcript or diploma.
A letter of financial support
- If you are financially supported by your family, please submit an original letter (in English) from the bank stating that you have US $6,564.00 to support you at the United States for six months. Also, submit a letter from your family that they will support you while you are in the IEP.
- If you are sponsored by a government or corporation, please submit a letter of financial guarantee.

Document last revised Wednesday, November 7, 2007 9:54 AM