EBETEC Application Form

INTERNATIONAL STUDENT

FINANCIAL STATEMENT FORM
Submission of this form is required of students before SEVIS documents can be issued by EBETEC Language Academy.

This form must be completed and signed to verify the evidence of financial support for the issuance of an I-20. Signatures, bank statement(s) dated within the last 3 months, and/or supporting verification documents are required.
Student Name - Provide your name exactly as it appears on your passport*

First NameMiddle NameLast Name
Student Birth Date*

MonthDayYear
Age*
Country of birth*
Place of birth (City)*
E-mail*
Phone Number*

Country CodeArea CodePhone Number
An I-20 cannot be issued until a bank statement proving financial ability has been received by EBETEC Language Academy. Financial documents dated more than 3 months prior to the date of I-20 issuance cannot be accepted.
Visa regulations require all F visa holders to provide certified evidence of adequate funds to meet tuition and living expenses for a proposed program of study.
Each student or personal sponsor (friends or family) must provide a statement or letter from the bank showing U.S. dollars or the type of currency where the account is held totaling the amount needed. EBETEC Language Academy requires US$ 13,000 for the Intensive English Program to be available per year.

• Approximate Annual Cost per Student: $13,000
• Approximate Annual Cost per Dependent: $5,500
SOURCE OF FINANCIAL SUPPORT
Please indicate your source(s) of funding as applicable. At least one source of funding must be indicated; not all sources of funding may apply to you.*

Personal FundsFamily or Individual Sponsor`s FundsOther
Please state the amount in U.S. dollars available to the student for use each year in the United States of America.*
e.g. $20,000.00
SPONSOR INFORMATION
Sponsor's Name*

First NameLast Name
Birth Date*

MonthDayYear
Sponsor's Age*
Sponsor's Country of Birth*
Sponsor's Place of Birth (City)*
Sponsor's address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Sponsor's e-mail*
example@example.com
Sponsor's Phone Number*

Country CodeArea CodePhone Number
Type of relationship*
DEPENDENT INFORMATION - F2
Spouse's name*

First NameLast Name
Country of birth*
Place of birth (City)*
Spouse's Birth Date*

MonthDayYear
Age*
Gender*
Phone Number*

Country CodeArea CodePhone Number
1 - Child's name*

First NameLast Name
Country of birth*
Place of birth (City)*
Gender*
Age*
2 - Child's name*

First NameLast Name
Country of birth*
Place of birth (City)*
Gender*
Age*
3 - Child's name*

First NameLast Name
Country of birth*
Place of birth (City)*
Gender*
Age*
4 - Child's name*

First NameLast Name
Country of birth*
Place of birth (City)*
Gender
Age*
DECLARATION
I consent to the information collected about me on this form being disclosed if authorized or required by law.
I declare that the information I have provided on this application form is true and complete and authorize the EBETEC Language Academy to obtain further information required to complete enrollment.
I agree to immediately notify the EBETEC Language Academy of any changes to the information I have given in this application form, including a change of address. I will notify EBETEC Language Academy immediately if there are any changes to my financial situation.
I understand that EBETEC Language Academy reserves the right to vary or reverse any decision regarding admission or enrolment made based on incorrect or incomplete information.
I understand that after my application is approved, I am required to study at EBETEC Language Academy for at least 16 weeks, and if I decide to transfer before the 16-week period a $880.00 Penalty Fee will apply.
I understand that if I withdraw from the program after the Transfer completion no refund will be issued.
I agree that I am fully responsible for all education and living expenses, both for myself and for all my dependents who accompany me while I am studying at the EBETEC Language Academy.
I understand that EBETEC Language Academy may terminate my enrollment agreement if I fail to fulfill my financial obligations to the school.
I understand that if I have a sponsor additional information will be requested and the sponsor must fill out the Affidavit of Financial Support Form.
Applicant's Signature*

Clear
Today's date*

MonthDayYear
Date
Time*

Hour Minutes

AM/PM Option
Please upload all applicable files. If applying with dependents you must submit their files.

F1 INITIAL (applying from your country)

1 - Copy of your Passport and copy of all dependent's Passports (If any).

2 - Bank statement or letter from the bank showing U.S. dollars or the type of currency where the account is held totaling the amount needed. Please upload the most recent Bank Statement showing your name or your sponsor's name.
Please upload all applicable files. If applying with dependents you must submit their files.

TRANSFER F1 VISA

1 - A Copy of your Passport and a copy of all dependent Passports (If any).

2 - A copy of your Student Visa or change of status approval notice.

3 - Bank statement or letter from the bank showing U.S. dollars or the type of currency where the account is held totaling the amount needed. Please upload the most recent Bank Statement available showing your name or your sponsor's name.

4 - A copy of your most recent I-20.

5 - Completed Transfer Form. You will be required to send us this form only after acceptance by EBETEC Language Academy.
Please upload all applicable files. If applying with dependents you must submit their files.

REINSTATEMENT (terminated students)

1 - A Copy of your Passport and a copy of all dependent Passports (If any).

2 - A copy of your Student Visa (F1 VISA) or change of status approval notice.

3 - Bank statement or letter from the bank showing U.S. dollars or the type of currency where the account is held totaling the amount needed. Please upload the most recent Bank Statement available.

4 - A copy of your most recent I-20.
Please upload all applicable files. If applying with dependents you must submit their files.

RE-ENTRY (You must have a valid Student Visa)

1 - A Copy of your Passport and a copy of all dependent Passports (If any).

2 - A copy of your Student Visa (F1 VISA).

3 - 3 - Bank statement or letter from the bank showing U.S. dollars or the type of currency where the account is held totaling the amount needed. Please upload the most recent Bank Statement showing your name or your sponsor's name.

4 - A copy of your most recent I-20.
Please upload all applicable files. If applying with dependents you must submit their files.

CHANGE OF STATUS

1 - A Copy of your Passport and a copy of all dependent Passports (If any).

2 - A copy of a valid Visa.

3 - A copy of your I-94.

4 - Bank statement or letter from the bank showing U.S. dollars or the type of currency where the account is held totaling the amount needed. Please upload the most recent Bank Statement showing your name or your sponsor's name.
File Upload*

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The next form must be signed by your sponsor. You can save this form and forward the link you will receive by e-mail to your sponsor if necessary.

INTERNATIONAL STUDENT

AFFIDAVIT OF FINANCIAL SUPPORT FORM
INSTRUCTIONS
Students must submit this form before SEVIS documents can be issued. An I-20 cannot be issued until EBETEC Language Academy receives an acceptable Affidavit of Financial Support and bank certification. Financial documents dated more than three months prior to the date of I-20 issuance cannot be accepted.
United States visa regulations require all F visa holders to provide certified evidence (Affidavit of Financial Support) of adequate funds to meet tuition and living expenses for a proposed program of study.
Documentation of Funds
Complete this form and provide documentation as required. All documentation of sources of support that you submit must:
• Include the sponsor’s name
• Be dated within the last 3 months
Bank Statement
Each personal sponsor (friends or family) must provide a statement or letter from the bank showing the total amount needed in U.S. dollars or the type of currency where the account is held.
The sponsor on the Affidavit of Financial Support and the account holder on the official bank statement must be the same.
A copy of the Articles of Incorporation is needed if the sponsor is a corporation.
Estimated Expenses
Approximate Annual Cost per Student: $13,000
Approximate Annual Cost per Dependent: $5,500
This amount represents an estimate of expenses associated with continuing your program of study at EBETEC Language Academy.
STUDENT INFORMATION
Student Name - Provide your name exactly as it appears on your passport*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Age*
Country of birth*
Place of birth (City)*
Native language *
Gender*
DEPENDENT INFORMATION
Spouse's name*

First NameLast Name
Country of birth*
Place of birth (City)
1 - Child's name*

First NameLast Name
Country of birth*
Place of birth (City)
2 - Child's name*

First NameLast Name
Country of birth*
Place of birth (City)
3 - Child's name*

First NameLast Name
Country of birth*
Place of birth (City)
4 - Child's name*

First NameLast Name
Country of birth*
Place of birth (City)
VERIFICATION / SPONSOR INFORMATION
This is to certify that I the undersigned have agreed to provide the funds indicated above (Estimated Expenses) to the applicant for the purpose of study at EBETEC Language Academy and that I am submitting bank statements indicating the availability of these funds and a copy of my personal documents.
Sponsor's Name*

First NameLast Name
Sponsor's Birth Date*

MonthDayYear
Sponsor's Age*
Sponsor's Country of Birth*
Sponsor's Place of Birth (City)*
Sponsor's address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Sponsor's e-mail*
example@example.com
Sponsor's Phone Number*

Country CodeArea CodePhone Number
Type of relationship*
DECLARATION
I certify that I made this affidavit to assure the U.S. Government that the student named above will not become a public charge in the United States.
I certify that the information I gave on this form is complete and accurate, and I understand that misrepresentation on this form may cause the rescindment of admission.
I agree to be fully responsible for all educational and living expenses, for both the applying student and any dependents accompanying them while studying at the EBETEC Language Academy.
I understand that EBETEC Language Academy may terminate the enrollment agreement if the student fails to fulfill the school's financial obligations.
Sponsor's Signature*

Clear
Today's date*

MonthDayYear
Date
Time*

Hour Minutes

AM/PM Option
Please upload all applicable files.

1 - Bank statement

Each personal sponsor (friends or family) must provide a statement or letter from the bank showing the total amount needed in U.S. dollars or the type of currency where the account is held.
The sponsor on the Affidavit of Financial Support and the account holder on the official bank statement must be the same.
A copy of the Articles of Incorporation is needed if the sponsor is a corporation.

2 - Sponsor ID

A Copy of the sponsor`s passport, Driver`s License, or ID card.
File Upload*

Cancelof

ELECTRONIC SIGNATURE AGREEMENT

By selecting the "I Agree and Accept the Terms and Conditions" option, you are signing the EBETEC Language Academy Application Form electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Application. By selecting "I Agree and Accept the Terms and Conditions" using any device, means, or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third-party verification is necessary to validate your E-Signature and that the lack of such certification or third-party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and EBETEC Language Academy. You are also confirming that you are the student authorized to enter into this Agreement.
CONSENT TO ELECTRONIC DELIVERY

By selecting the “I Agree and Accept the Terms and Conditions” option, you specifically agree to receive, obtain, and/or submit any and all EBETEC Language Academy documents and information electronically. These documents and information will be collectively known as "Electronic Communications" and will include, but not be limited to, any and all current and future required notices, tuition invoices, and/or disclosures concerning EBETEC Language Academy Regulations. You are acknowledging that you are able to use the email you provided in this agreement and are able to retain Electronic Communications by printing and/or downloading and saving this Agreement and any other agreements, Electronic Communications, documents, or records that are signed using your E-Signature. You accept Electronic Communications provided via email as reasonable and proper notice for the purpose of fulfilling any and all rules and regulations and agree that such Electronic Communications fully satisfy any requirement that communications be provided to you in writing or in a form that you may keep.
EMAIL AND TEXT MESSAGES - CONSENT TO ELECTRONIC COMMUNICATION

By signing this application, I authorize EBETEC Language Academy to send me future written correspondence regarding my account(s) via email and/or text messages. By consenting to electronic communication and invoices, I agree to receive all communications, including but not limited to invoices, statements, notices, warnings, and other relevant documents, electronically via email and/or text messages. My email and/or text messaging authorization does not obligate EBETEC Language Academy to communicate with me by email and/or text messages to my cell phone or cease non-electronic communication. I am advised that some circumstances may prevent EBETEC Language Academy from responding to my inquiry by email and/or text messaging.

By signing this Agreement with EBETEC Language Academy, I acknowledge:
- I own the e-mail and phone number account I have provided.
- The e-mail address provided is a personal email address and is not provided or owned by a company.
- The cell phone number provided is my personal cell phone number and is not provided by a company.
- By signing this Agreement, I authorize EBETEC Language Academy to contact me via email and/or text messages without any time restrictions.
- I agree to keep EBETEC Language Academy informed of my current Cell Phone number and will notify EBETEC Language Academy if the number is no longer in my possession.
- I hereby consent to electronic delivery for invoices and all other communications related to debt collection, hereby waiving any restrictions imposed by the Florida Consumer Collection Practices Act (FCCPA) and the Fair Debt Collection Practices Act (FDCPA) regarding the timing of communication. I understand that communication may occur between the hours of 9 p.m. and 8 a.m. without any limitations or restrictions. By providing this consent, I acknowledge that I have the ability to access electronic communications during these hours and that I am responsible for reviewing and responding to them in a timely manner. This consent supersedes any conflicting provisions of the FCCPA and the FDCPA.
- Additionally, by signing this Agreement and authorizing the communication by e-mail and/or text message, I understand that EBETEC Language Academy cannot guarantee the security or privacy of confidential information when communicating by e-mail and/or text messaging.
CONSENT TO COLLECT SUBMITTER IP ADDRESS - ONLINE FORMS

By selecting the ''I consent to EBETEC Language Academy collecting my IP address each time I submit one of their online forms'', you consent to the collection and storage of your IP address every time you use or submit an EBETEC Language Academy online Form for the purpose of verifying submissions and ensuring the security of electronic forms used by our institution. Your IP address will only be accessible to authorized personnel from EBETEC'S schools and will not be shared with any third parties unless required by law.
Signature*

Clear
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option

ATTENTION

After all your information is received and approved by EBETEC Language Academy we will send you an invoice by e-mail and/or by text message.

After we receive your payment, EBETEC Language Academy will issue your acceptance letter and I-20 Form, if applicable.
Should be Empty:

Registration Fee (Non-Refundable)	$240.00
Tuition Fee	$440.00 (limited-time offer)
Total amount charged	$680.00

Registration Fee (Non-Refundable)	$240.00
Tuition Fee	$440.00 (limited-time offer)
Total amount charged for the application	$680.00

Change of Status Registration Fee	$680.00
Total amount charged for change of status	$680.00

INTERNATIONAL STUDENT

DEPENDENT INFORMATION - F2

DECLARATION

REFUND POLICY

INTERNATIONAL STUDENT

SOURCE OF FINANCIAL SUPPORT

SPONSOR INFORMATION

DEPENDENT INFORMATION - F2

DECLARATION

INTERNATIONAL STUDENT

INSTRUCTIONS

STUDENT INFORMATION

DEPENDENT INFORMATION

VERIFICATION / SPONSOR INFORMATION

DECLARATION