Fillable Language Program Application (Eastern Florida State College)

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Language Program Application (Eastern Florida State College)

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The Language Program Application (Eastern Florida State College) form is 3 pages long and contains:

  • 2 signatures
  • 37 check-boxes
  • 43 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Eastern Florida State College

BROWSE EASTERN FLORIDA STATE COLLEGE FORMS

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IntensIve englIsh Program aPPlIcatIon Form
Please answer all questions and type or print clearly.
STUDENT INFORMATION
(Enter information as it appears on your passport)
Family Name: First Name: Middle Name:
Date of Birth (Month/Day/Year): Country of Birth: Country of Citizenship:
Gender: r Male r Female
Email: Phone:
SSN:
In compliance with Florida statute 119-07(1): SSN is requested for the sole purpose of registering noncredit, continuing education students. SSN’s are condential, are immediately converted to student
ID or “B” numbers to insure condentiality and may be used for no other purpose. SSN’s may only be disclosed to another agency or governmental entity if necessary for the receiving agency or entity to
perform its duties and responsibilities as authorized by law.
Student Address in Home Country
Street address:
City/Province:
Country:
Postal Code:
Please check the session for which you are applying:
r Summer Session (May – Aug.) r Fall Session (Aug. – Dec.) r Spring Session (Jan. – May)
Future Plans
What do you plan to do after studying English?
r Study in the United States
r Study at
EFSC
r Study in my home country
r Work in the United States r Work in my home country r Other:_______________
Applicant’s Signature: ____________________________________________________ Date: ________________
Please complete the Application and Financial support Information and mail it with the following:
1.
A non-refundable $100 is due for processing in the form
of a bank certified check or money order
payable to Eastern Florida State College.
2. An original bank statement showing nancial support.
3. A copy of high school diploma. (Translation to English included)
COMPLETE AND RETURN THE ABOVE PAGE TO:
INTENSIVE ENGLISH PROGRAM
Eastern Florida State College
250 Community College Parkway
Palm Bay, FL 32909
Telephone: (321) 433-7516 • Fax: (321) 433-7531 • e-mail: dobrosielskia@
easternflorida.edu
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signature
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FINANCIAL INFORMATION
In order to receive an I-20, you must complete this form and provide a nancial statement from you or your sponsor
certifying that you enough funds for tuition and living expenses while you are in the U.S. Send a current bank statement
or a letter of nancial support for the minimum sum of $25.000.00 for your academic year. Bank statements should not
be more than 3 months old. If your sponsor is unable to complete this form, a separate letter of support can be submitted
with this application.
Please indicate the source and amount of funds available for your rst academic year (minimum of
$25.000.00).
$___________ PERSONAL FUNDS – You will need to submit an original of your bank statement or similar document.
$___________ SCHOLARSHIP – if you have a scholarship or nancial support from an organization, we will need a
Letter of Financial Guarantee addressed to Eastern Florida State College. The
letter must state the
period of coverage.
$___________ FAMILY OR OTHER SUPPORT – You must provide the following statement signed by the person who will
be responsible for your expenses
while you are at Eastern Florida State College.
Please complete the following:
Student’s name:
Sponsor’s name:
Relationship with sponsor:
Address:
Country:
Phone number:
I
hereby certify that I will be financially responsible for the expenses of the above referenced student during his/her
stay at Eastern Florida State College. I am able to provide the amount indicated above for one academic year.
Sponsor’s Signature: ____________________________________________________ Date: ________________
Please be sure to attach bank statements, letter from bank official, letter from employer or other documents verifying your
ability to cover the student’s expenses.
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signature
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FAMILY INFORMATION
If you plan to bring your spouse and/or your children with you to the U.S., they will need to be included on your I-20.
Submit a copy of each dependent’s passport. An additional $4,000 must be included in the nancial guarantee for each
dependent per semester.
Family Name: First Name: Middle Name:
Date of Birth: (Month/Day/Year) Country of Birth: Country of Citizenship:
Gender: r Male r Female Relationship to you: r Child r Spouse
Family Name: First Name: Middle Name:
Date of Birth: (Month/Day/Year) Country of Birth: Country of Citizenship:
Gender: r Male r Female Relationship to you: r Child r Spouse
Family Name: First Name: Middle Name:
Date of Birth: (Month/Day/Year) Country of Birth: Country of Citizenship:
Gender: r Male r Female Relationship to you: r Child r Spouse
How did you First Find out about EFSC’s Intensive English Program?
r A search for English programs
on internet
r Found the link on another
web page
r EFSC's web
site
r A friend or family member
recommendation
r IEP Brochure r A past or present student
from IEP
r U.S. Embassy or Consulate r Advertisement in print or
online magazine
r Other___________
Application Checklist
r Non-refundable $100 Application Fee (we accept money orders and bank checks by mail)
r Copy of transcripts and/or diploma from high school (include translation)
r Proof of nancial responsibility
r Copy of passport
r Copies of current visa and I-94 (if applicable)
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Language Program Application (Eastern Florida State College)

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Completed 24 July 2020

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