Use this form to enroll in the Year 2000 Special
from September 18 - October 2, 2000!
Special Session: September 18 - October 2, 2000
Super Intensive English Language and Cultural Immersion Program
Please complete and submit this form. Our Program Coordinator will contact
you with regard to method of payment.
Refer to Admissions Information for additional
information on admission requirements. We will contact you with information specific
to your individual needs.
Thank you very much! Note: Inputs fields with an asterisk (*)
are required.
* Name
Title
Company
* Address
* City
* State/Province
* Zip/Postal code
* Country
* Country Code
* City Code
* Work 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 Taken? (mm/dd/yyyy)
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 Questions
If you have any questions or specific requests, please submit below.
Questions or Specific Requests
