USAELC Apply Online

USA English Language Center

Application Form

Full Legal Name*

First/Given Name, Middle Name, Last/Family Name

Gender:*

MaleFemale

Birth Date*

MonthDayYear

Country of Birth*

Country of Citizenship:*

Email*

example@example.com

Home Number

Mobile Number

Current Visa Status:

F (student)B (tourist)J (work)Other

2. Start Date at USA English Language Center

Desired Start Date:

MonthDayYear

How long would you like to study at USAELC?

(months/years)

3. Permanent Address (Home Country) Required for I-20

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

4. Local Address (inside the US)

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

5. Student Visa (F)

Will You need an I-20 from USAELC (student visa)?

YesNo

6. Transfer Students Only

Name of Your Previous School

Date of Your Last Day at Previous School

MonthDayYear

If You are on Student Visa (F), are you currently in Active Status and Eligible for Transfer?

Yes, I am in Active StatusNo, My I-20 is: Terminated, Completed, Initial Status

7. Emergency Contact

Name of Closest Relative:

Relationship to you:

Phone Number

E-mail

example@example.com

8. How Did You Hear About Us?

Instagram

Facebook

Google

Friend

Agent

Other

9. Do You Need Help With Housing?

USAELC does not have on-campus housing but we can email you third party housing options.

Yes, I send me housing informationNo, I will find my own housing

10. Payment

I am allowing USAELC to charge the following today to the below Credit Card Provided: Abroad booking fee applies to any student entering the US through USAELC on a student visa. All fees in this section are non-refundable.

My Products

Registration fee For any new student applying to study at USAELC.

$95.00

Abroad Booking Fee You are outside of the USA and need a Student Visa

$300.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

If you wish to make a payment with Check or Wire Transfer Please Call 1.619.297.1999 or email: admissions@usaelc.edu

Student Signature Required

Full Name*

First NameLast Name

Signature

By checking the below box you are signing this application and you are confirming that you would like to apply to the English Language Program at the USA English Language Program and that the information provided is accurate to the best of your knowledge:*

I accept

Copy of you Passport (First 2 pages)

Bank Statement

Other

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