Application Form

American English Academy

APPLICATION FORM
Reason for Issue
School Location
A. APPLICANT INFORMATION
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Gender
Date of Birth

MonthDayYear
Date
DO YOU HAVE ANY DEPENDENTS WITH YOU?
Country of Birth
Country of Citizenship
HOME ADDRESS

Street Address

City

CityState

Zip CodeCountry
B) STUDENT ENROLLMENT INFORMATION
Session Start Date

MonthDayYear
Date
Duration of your stay
C) APPLICANT'S FINANCIAL DATA
Funding for Tuition and Living Expenses will come from
REFUND POLICY
- The registration fee is non-refundable.
- 50% tuition refund if the student drops out during the first week of classes.
- No refund after the first week of classes.
- A refund will be credited electronically via Stripe.
DISCLOSURE ACKNOWLEDGEMENT: I am applying for a student visa to improve my English language skills at American English Academy. I fully understand the terms and conditions of my enrollment including refund policies and U.S. Immigration reporting requirements. I am aware that once my visa is approved, information concerning my enrollment and attendance will be reported regularly to the USCIS by American English Academy as required by Federal Law.
Applicant's Signature
Today's Date

MonthDayYear
Date
American English Academy
hello@aea.edu / www.aea.edu
Should be Empty:

American English Academy