USAELC Miami Application Form

1. Application Information
Full Legal Name*
First/Given Name, Middle Name, Last/Family Name
Gender:*

MaleFemale
Birth Date*

MonthDayYear
Country of Birth*
Country of Citizenship:*
Email*
Home Number*

Area CodePhone Number
Mobile Number

Area CodePhone Number
Current Visa Status:
2. Start Date at USAELC

When would you like to start?
Desired Start Date:

MonthDayYear
How long would you like to study at USAELC?
(months/years)
3. Permanent Address
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

Area CodePhone Number
E-mail
8. How Did You Hear About Us?
Internet
Friend
Agent
Fair
Magazine
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.
Name on Credit Card
If you wish to make a payment with Check or Wire Transfer Please Call 1.619.297.1999 or email: admissions@usaelc.com
Student Signature Required
Full Name*

First NameLast Name
Signature

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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
Today's Date

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Please upload a copy of your drivers license or photo ID.
Photo ID

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2. Start Date at USAELC

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