USAELC Miami Beach – Student Registration Form

USAELC Miami Beach – Student Registration Form

Complete this form to register for your upcoming English language class at USA English Language Center in Miami Beach.
Student Information
Student name

First NameLast Name
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I confirm that I am 18 years of age or older.
Gender
Country of Birth
Country of Citizenship
Native Language
Email address
example@example.com
Mobile / WhatsApp Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact
Emergency Contact Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
English Background and Placement
How would you describe your current English level?
Have you studied English before? If yes, where and for how long?
What is your main reason for studying English?
All new students take an English placement test on campus, supervised by our staff, before their first class. Bring a photo ID. Your class level is based on your placement test score.
How Did You Hear About USAELC?

Other
Student Acknowledgments
I will receive the USAELC Student Handbook, and I agree to follow its policies on attendance, grading, class progression and student complaints.
I understand that I will take a placement test before my first class.
I understand that USAELC does not provide housing.
I understand that USAELC does not provide health insurance, and I am responsible for having adequate health insurance coverage.
I confirm that the information I provided is accurate and complete.
Identification and Signature
Photo ID (passport, driver's license or other government-issued ID)

Cancelof
Signature
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Select a class
Choose your class schedule
Class details: 2 hours of instruction per week (two 1-hour classes) in a 12-week session. Tuition: $0. Students purchase the Reflect Listening & Speaking e-book with Spark access ($60). Students complete quizzes, a midterm and a final exam and receive a grade report at the end of the session.
I would also like to be contacted when these classes open:
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Should be Empty:

USAELC Miami Beach – Student Registration Form

Student Information

Emergency Contact

English Background and Placement

Student Acknowledgments

Identification and Signature