Refer to Admissions Information for additional
information on admission requirements. We will contact you with information specific
to your individual needs.
To inquire on-line, please fill in the following input fields on
this form and then click the submit button at the bottom of the page.
Thank you very much!
Note: Inputs fields with an asterisk (*)
are required.
*
Name
Title
Company
*
Street address
*
City
*
State/Province
*
Zip/Postal code
*
Country
* Phone
Home Phone
FAX
*
E-mail
*
Date of birth
*
Sex
MaleFemale
#2 Inform us of your academic background.
Number of years studying English :
If more than 3, specify:
Level of English proficiency:
Do you plan to study at an American university or college?
Yes No
Have you ever taken the TOEFL? Yes No
If yes, what was your score?
Date? (month) (day) (year)
Education (college or other post/secondary):
How did you hear about English Connection?:
#3 Issuance of I-20 Form (Student Visa)
Students admitted to ENGLISH CONNECTION receive a Certificate of
Eligibility (Form I-20) to obtain a student visa at the nearest U.S. embassy or consulate.
Students should check there for any restrictions that apply. If a student's primary
purpose for entering the United States is to study full-time it is important to obtain the
F-1 student visa.
Will you apply for a student visa? YesNo
#4 Health Insurance
Do you have personal health insurance? YesNo
Do you need health insurance from ENGLISH CONNECTION? YesNo
#5 Course Sessions
ENGLISH CONNECTION offers rolling admissions with sessions
beginning every Monday for any duration students desire. Our Intensive English Language
& Cultural Immersion Programs run Monday through Friday, 4 hours daily (20 hours of
classroom instruction per week). Super Intensive English Language Programs (30 hours per
week) are also available. Private instruction only, or private instruction in addition to
classroom instruction is also available. All program fees are inclusive of tuition,
accommodation and meals where indicated.
Course Sessions
Select the desired type of session you desire.:
#6 Session Dates
Session Dates
Select the desired dates you would like to attend.
#7 Year to Attend
Year
Select the desired year you would like to attend.
#8 Select the type of accommodation you desire.
Accommodations
Check the desired type of accommodation you desire.
Teacher w/meals
Host Family w/meals
Hotel (see notes)
Apartment (see notes)
Dormitory w/meals
Notes: Accommodation in hotel varies. Contact our office for seasonal rates and
preferences.
#9 Select Intensive or Super Intensive Program.
Intensive or Super Intensive Programs
Check the desired type of program you desire.
Intensive English Program
Super Intensive English Program
#10 Select yes for more information.
Professional & Corporate Programs
Select yes if you would like more information regarding our Professional & Corporate
English Programs.
