Online Application
Student Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Gender on your passport
*
Male
Female
X
Did you see our promotion on any of the following websites?
Google
Instagram
YouTube
Facebook
Tiktok
その他
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Course
*
Student Visa (F1) / I-20 Course (20 hours or more)
Non I-20 Course (Less than 18 hours) / ex. ESTA, E Visa
Kama‘aina (20 Hour or more/week)
Kama‘aina (15 Hour/week)
Kama‘aina (10 Hour/week)
Afternoon Course (F1 Transfer only)
Start Date
*
-
月
-
日
年
Please write down your desired start date.
Length of Study
*
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1 weeks
2 weeks
3 weeks
4 weeks
5 weeks
6 weeks
7 weeks
8 weeks
12 weeks
16 weeks
20 weeks
24 weeks
28 weeks
32 weeks
36 weeks
40 weeks
44 weeks
48 weeks
other
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Personal Information — for Student Visa (F1) Applicants
Country of Citizenship
*
Country of Birth
*
Do you already have a valid F-1 Visa?
*
Yes
No, I will apply
No, I will change my status
Other
Do you have dependents who will apply for an F-2 Visa?
*
Yes
No
Foreign Address
Address in your home country
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
*
Phone Number
Contact Number in your home country
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Transfer Students
Are you transferring from another school?
*
Yes
No
School Name
Program Name
Last Day of Study at Current School
-
月
-
日
年
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Address in Hawaii
(If known)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
Local (U.S.) Phone Number
Please Read and Acknowledge
By checking the boxes below, you are acknowledging you understand Academia's policies.
*
I understand that Academia has the right to change policies, prices and programs without prior notice.
I certify that the information provided on the application form is correct.
I will be responsible for reading, understanding, and accepting all school policies. I further agree to all terms and conditions provided by Academia Language School.
I have read, understand and agree to Academia's Refund Policy.
If a student is under 18 years old, then a legal guardian must sign on behalf of the student.
Academia's Refund Policy
Date Signed
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Submit
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