Please type the information requested on this application form and then print it from your computer. Print the Declaration and Certification of Finances (DCF), fill it in, and have your sponsor sign it. (Click here for a copy of the DCF.)

See the last page of this form for a list of everything to include with your application. Mail the application materials, the $50 application fee, and the $200.00 SEVIS Fee to the address given above.

PLEASE PRINT OR TYPE ALL INFORMATION. COMPLETE ALL THE PAGES OF THIS FORM AND THE DCF.

NOTE: Admission to the English Language Institute is not the same as admission to The University of Akron for a degree program. For information about applying to an undergraduate degree program at this University, see International Student Admissions. For information about applying to a graduate degree program, see Graduate School International Admissions.

Month: Day: Year:

When do you want to begin your classes at the English Language Institute? Type or print an X in the correct box.



Summer Semester 2009 (June 8 to August 5, 2009)	Spring Semester 2010 (January 11 to May 5, 2010 )
Fall Semester 2009 (August 24 to December 9, 2009)	Summer Semester 2010 (June 7 to August 4, 2010 )

FAMILY NAME:
(This is your Last Name or Surname. Be sure to use the same spelling as your passport.)

FIRST NAME:
Middle Initial or Name (if included on your passport):

Nickname:

MAILING ADDRESS (Your admission letter and I-20 will be sent here):






PERMANENT ADDRESS in your country if different from your mailing address:





Telephone Number: FAX Number:

E-MAIL Address:

BIRTHDATE: Month: Day: Year: AGE: SEX: Male Female

COUNTRY OF BIRTH: CITY OF BIRTH:

COUNTRY OF CITIZENSHIP: NATIVE LANGUAGE:

PASSPORT NUMBER (if available):

Do you have any medical problems which could affect your studies in the ELI? Yes No
If yes, please describe:


NOTE: When you mail your application, please send a photocopy of your passport page with your name and the dates of issuance and expiration on it.

Have you graduated from (finished) high school? Yes No

Have you graduated from a university/college degree program? Yes No
If yes, please indicate the following:
Two-year technical degree Four-year undergraduate degree Master's/Ph.D. Degree

Other (explain):
If you plan to study at a U.S. university, what will your major or department be?

Have you applied for admission to The University of Akron?
Yes, as an Undergraduate Student Yes, as a Graduate Student

No, but I plan to study at a U.S. university. No. I do NOT plan to study at a U.S. university.

If you have applied to The University of Akron, have you received a letter of conditional admission? Yes No
Are you transferring to the ELI at The University of Akron from another U.S. school? Yes No
If yes, which school did you attend?

If you intend to transfer from another U.S. school, please send with this application an official letter or transcript from the school which confirms the dates of your enrollment and verifies your immigration status.
What is your job in your country? Student Other. If other, please explain:

Have you studied English before? Yes No
If yes, how long have you studied English? Write the number of years or months:

Years Months
Where have you taken classes in English? (Check all that apply.) High School University

Other. Please describe:
Have you taken the TOEFL Test? Yes No
If yes, what was the date of your TOEFL test? What was your score?

Please attach a copy of your TOEFL score. (NOTE: You do not need a TOEFL score to attend the English Language Institute. Your score will help us determine your placement in our English classes.)
In your opinion, what is your English ability at this time?



Grammar	poor	fair	good	excellent
Vocabulary	poor	fair	good	excellent
Reading	poor	fair	good	excellent
Writing	poor	fair	good	excellent
Listening	poor	fair	good	excellent
Speaking	poor	fair	good	excellent



Why do you want to study English? For university studies in the U.S. For personal reasons

For professional reasons (job in your country) For other reasons. Please explain:

What will your immigration status be? Check one:

Please Note:
*If you need an F-1 student visa to enter the U.S., you will have to pay the $200.00 SEVIS Fee AFTER you are issued a Form I-20 and BEFORE you apply for your visa. To make this process easy for you, the ELI will submit your SEVIS fee on the Internet, print the receipt for you, and mail it to you with your I-20 travel document. If you prefer, you can process the SEVIS Fee payment yourself.

**F-2 visa holders are NOT eligible to study full-time at the English Language Institute. However, you may study as a part-time student. To study full time, you must apply for an F-1 visa.

***B-1 and B-2 visa holders are NOT eligible to study full-time at the English Language Institute. However, if language study is incidental to your primary purpose for traveling to the U.S., you can study as a part-time student. To study full-time, you must apply for an F-1 visa.

Do you have a U.S. Social Security number? Yes No
If yes, write your Social Security number here:

Are you travelling to the U.S. with a spouse (husband or wife)? Yes No
If yes, spouse's name (copy it exactly from his or her passport:
Are you travelling to the U.S. with children? Yes No
If yes, number of children:
1st Son's Name (copied from passport):

2nd Son's Name (copied from passport):

3rd Son's Name (copied from passport):

1st Daughter's Name (copied from passport):

2nd Daughter's Name (copied from passport):

3rd Daughter's Name (copied from passport):


Note: Please include a photocopy of each dependent's passport page with his/her name and the dates of issuance and expiration on it.

In addition, your financial support documents, that is, your Declaration and Certification of Finances and your bank letter, must show that you have enough money available to support your spouse and each child for each semester. See the Declaration and Certification of Finances for details.

How did you learn about the English Language Institute at The University of Akron?
Friend (name):
• Did this person study at the ELI? Yes No
  
  
• Did this person study at The University of Akron? Yes No
Relative (name):
• Did this person study at the ELI? Yes No
  
  
• Did this person study at The University of Akron? Yes No
Advisor (name):

Agency (name):

Directory of English Language Programs and/or universities (name):

The Internet (name of site):

Other (please explain):

• Application Form
• Declaration and Certification of Finances (DCF)
• Official Bank Letter (See page 1 of the DCF for information on the bank letter.)
• A photocopy of your passport page with your picture and the issue and expiration dates.
  If you come to the U.S. with dependents, send photocopies of their passport pages too.
• Transfer Letter, if applicable.
• Non-refundable Application Fee ($50).

• I want the ELI to submit the SEVIS Fee for me. I am enclosing payment for this $200.00 fee. I understand that if I pay by credit card, the ELI will use the card number written below for my SEVIS fee payment.
  
  OR
  
  
• I want to process the SEVIS fee myself. I will pay the $200.00 after I receive my Form I-20.
  
  You can pay the $50.00 application fee and the $200.00 SEVIS Fee in one of two ways:
  
  
  1. Send a check or money order payable through a U.S. bank. Do not send cash. Make the check or money order payable to The University of Akron/ELI.
  
  2. Pay by credit card. Type of Card: VISA MASTERCARD DISCOVER
  Name that appears on the card:
  
  Billing Address of Card Holder:
  
  
  
  
  Account Number:
  
  PIN Number:
  
  Expiration Date: Month Year
  
  Signature:
  
  Credit card payments can also be accepted by telephone and fax.
  
  Put an X here if you would like your Admission Letter and Immigration Document (I-20A-B and SEVIS receipt) sent to you by DHL Express Mail. The minimum charge for DHL service is $40.00 U.S. If the cost for express mail to your address is more than $40.00, we will contact you and ask that you pay the full amount.
  
  
  For this service, please send:
  • a separate check or money order payable to The University of Akron/ELI.
    
    OR
    
    
  • pay by credit card. We will charge the DHL fee to the credit card listed above.