ALI Student Application

ALI Student Application
*Required Field
Student Name and Address Information
Student Information
First Name*
___________________________________________________________
Family Name*
_________________________________________________________
Middle Name(s) _________________________________________________________
Date of Birth* (MM/DD/YY) _________________________________________________
Sex*
□ Male
Country of Birth*
□ Female
_____________________________________________________
Country of Citizenship*____________________________________________________
Student Email* _________________________________________________________
Alternative/Agent Email_____ [email protected] _______________________________
Student’s Permanent address in Home Country
Permanent Address* _____________________________________________________
City*
________________________________________________________________
State/Province
Country*
_________________________________________________________
______________________________________________________________
Postal Code * __________________________________________________________
Telephone Number* _____________________________________________________
Seite 1/ 10
IEC Online GmbH
International Education Centre
Marienstraße 19/20, 10117 Berlin, Germany
Tel. +49-30-204586-87/-89
Fax +49-30-204586-88
[email protected], www.ieconline.de
Amtsgericht Berlin-Charlottenburg
HRB 115287 B
Geschäftsführerin: Hilka Leicht
Program Information
Select Program
□
□
□
□
□
□
□
Start Date
(MM/DD/YY)
End Date
(MM/DD/YY)
#of Weeks
Intensive English for
Communication (IEC)
□ Full Term
□ A Session only
□ B Session only
□ Flex entry
□ Part-time
Business English
English for Academic Purposes
Pre-MBA/Graduate Business
Program
Semester at SDSU General
Courses
Semester at SDSU Business
Courses
Semester at SDSU Certificate
Programs
(select one)
□ Business Certificate
□ Hospitality, Tourism and
Recreational Management
□ Sustainable Tourism
Management
□ Performing in Music
□ Perspectives in Music
□ Environmental Studies
Seite 2/ 10
IEC Online GmbH
International Education Centre
Marienstraße 19/20, 10117 Berlin, Germany
Tel. +49-30-204586-87/-89
Fax +49-30-204586-88
[email protected], www.ieconline.de
Amtsgericht Berlin-Charlottenburg
HRB 115287 B
Geschäftsführerin: Hilka Leicht
□
□
Semester at SDSU
Summer Term
□ Full Term
□ A Session only
□ B Session only
Business for Global
Practices (BGP)
Certificate
□ Full Term
□ A Session only
□ B Session only
TESL/TEFL Certificate
□
□
TEFL Seminar (please
attach proof of prior
teaching experience)
Visa Information
Please complete this VISA Information section if you will need an F-1 student visa to enter the United
States for full-time study at the American Language Institute. To apply for an F-1 student visa at the
U.S. Embassy or consulate in your home country, you will need an I-20. To receive an I-20, you must
complete this form and provide a financial statement from your bank, certifying that you have
enough funds for tuition and living expenses while you are in the U.S. If you do not need an F-1
student visa, please proceed to the Transfer Information section on the lower portion of this page.
□ Yes, I want to apply for an I-20
□ No, I do not want to apply for an I-20
Amount Needed
The amount of funds you need will depend on the cost of the program you want to take
plus approximately $1,000 per month for living expenses. All students on an F-1 student
status must have health insurance coverage. In addition, if you are bringing dependents,
you should estimate an additional $500 per month for a spouse and $250 per month for a
child.
Seite 3/ 10
IEC Online GmbH
International Education Centre
Marienstraße 19/20, 10117 Berlin, Germany
Tel. +49-30-204586-87/-89
Fax +49-30-204586-88
[email protected], www.ieconline.de
Amtsgericht Berlin-Charlottenburg
HRB 115287 B
Geschäftsführerin: Hilka Leicht
Source of Funds
□ Self
□ Family
□ Other: ___________________________________
Affidavit of Financial Support
If you checked 'family' or 'other' under 'Source of Funds,' the person who is financially
responsible for you must read and sign the statement below.
I have read the information about the tuition, health insurance and living expenses for the
period of study at the American Language Institute at San Diego State University. I certify
that these funds are available and I accept full responsibility for these expenses.
Printed name of person financially responsible__________________________________
Current Date_____________________________________________________________
Sponsor’s Funds
If you are sponsored by a company, agency, foundation or government agency, you will
need to send a letter from that sponsor that specifies which costs the sponsor will pay.
Name of sponsoring company, agency, foundation or government agency
________________________________________________________________________
Family Information
If you are bringing family members with you to the U.S., they will need to be included on
your I-20.
Please estimate an additional $500 per month for a spouse and $250 per month or a child.
□ No Family Members
Seite 4/ 10
IEC Online GmbH
International Education Centre
Marienstraße 19/20, 10117 Berlin, Germany
Tel. +49-30-204586-87/-89
Fax +49-30-204586-88
[email protected], www.ieconline.de
Amtsgericht Berlin-Charlottenburg
HRB 115287 B
Geschäftsführerin: Hilka Leicht
Family Member 1:
Last Name*
First Name*
Birth Date
(MM/DD/YY)*
Country of Birth*
Relationship*
□ Spouse
□ Child
Sex*
Country of
Citizenship*
Family Member 2:
Last Name*
First Name*
Birth Date
(MM/DD/YY)*
Country of Birth*
Relationship*
□ Spouse
□ Child
Sex*
Country of
Citizenship*
If you are bringing more than two family members with you to the U.S., please include the
relevant information about these family members on a separate sheet.
Transfer Information
Have you ever attended the ALI before?
□ No
□ Yes
Were (or are) you currently attending another school in the U.S.?
□ No
□ Yes
If yes, your school must complete and return the ALI Transfer Eligibility Form before we can
give you an I-20.
Mailing Information
I-20 and other information to be sent (select method):
□ Pickup at ALI
□ Mail by Express Airmail
□ None
Housing Information Request
Note: Homestay/On-campus housing will be assigned based on availability. There is NO
GUARANTEE that you will receive a space.
Please send me information about (*Required at least one selection)
□ Dormitory / Campus Apartments*
□ Homestay*
□ I do not need housing*
Seite 5/ 10
IEC Online GmbH
International Education Centre
Marienstraße 19/20, 10117 Berlin, Germany
Tel. +49-30-204586-87/-89
Fax +49-30-204586-88
[email protected], www.ieconline.de
Amtsgericht Berlin-Charlottenburg
HRB 115287 B
Geschäftsführerin: Hilka Leicht
ALI Campus Housing
Campus Housing List
Please select up to 2 preferred dorm/campus housing packages
Tenochca Residence Hall
Prices are for SHARED bedrooms with shared bathrooms and a limited meal plan. All
students will share a bedroom with one other ALI student and a large community bathroom
with a full floor of students. Each room is furnished with 2 twin-sized beds, 2 desks and
chairs, 2 wardrobes, 2 dressers, and 1 microwave/mini-fridge. Linens (blankets, sheets, and
1 pillow) are included. All utilities (except personal phone) are included in the price. Please
see http://ali.sdsu.edu/residencehalls for more information.
Package
Spring 13 – Full Semester
Spring 13 – Session A
Spring 13 – Session B
Dates
TBA
TBA
TBA
Price
TBA
TBA
TBA
1st Choice
□
□
□
2nd Choice
□
□
□
Piedra del Sol Campus Apartments
The Piedra del Sol (PDS) apartments are located across the street from the ALI. The ALI
rents a limited number of PRIVATE bedrooms in 4-bedroom / 2-bathroom apartments to ALI
international students, and the remaining apartments are filled with American students who
attend San Diego State University. Students will share an apartment with other ALI students,
not with American students. Each apartment is furnished with: lamps, sofa, coffee table,
vacuum cleaner, dining table and chairs. Each bedroom is furnished with: 1 twin-size bed,
dresser, nightstand, desk, and desk chair. There are NO televisions, dishes, pots, pans or
linens (sheets, towels, blankets or pillows) provided by the ALI. These items may be brought
from home or purchased after arrival. Piedra del Sol apartments are NOT for short-term
study or IEC "Flexible Entry" students. Read detailed information about Piedra del Sol by
visiting http://ali.sdsu.edu/apartments
Package
Spring 13
Dates
TBA
Price
TBA
1st Choice
□
2nd Choice
□
Seite 6/ 10
IEC Online GmbH
International Education Centre
Marienstraße 19/20, 10117 Berlin, Germany
Tel. +49-30-204586-87/-89
Fax +49-30-204586-88
[email protected], www.ieconline.de
Amtsgericht Berlin-Charlottenburg
HRB 115287 B
Geschäftsführerin: Hilka Leicht
Villa Alvarado Apartments
The Villa Alvarado (VA) apartments are located on the east side of the SDSU campus. The
ALI rents a limited number of SHARED bedrooms in 2-bedroom / 1-bathroom apartments to
ALI international students, and the remaining apartments are filled with American students
who attend San Diego State University. Students will share an apartment with other ALI
students, not with American students. Each apartment is furnished with: lamps, sofa, coffee
table, dining table and chairs. Each bedroom is furnished with: 2 twin-size beds, 2 dressers,
2 desks, and 2 desk chairs. There are NO televisions, dishes, pots, pans or linens (sheets,
towels, blankets or pillows) provided by the ALI.
These items may be brought from home or purchased after arrival. The Villa Alvarado
apartments are NOT for short-term study or IEC "Flexible Entry" students. Read detailed
information about Villa Alvarado by visiting http://ali.sdsu.edu/apartments.
Package
Spring 13
Dates
TBA
Price
TBA
1st Choice
□
2nd Choice
□
ALI Homestay
Homestay Preferences
Start Date Housing Needed* _________________________________________________
End Date Housing Needed* _________________________________________________
Do you smoke?*
□ Yes
□ No
Allergic to dogs?*
□ Yes
□ No
Allergic to cats?*
□ Yes
□ No
Is living with children (under 10 years) ok?*
□ Yes
□ No
Special food request (vegetarian, allergies...)? ___________________________________
What kind of transportation will you use (public, buy/rent car...)? _______________________
Notes:
_________________________________________________________________________
_________________________________________________________________________
____________________
Seite 7/ 10
IEC Online GmbH
International Education Centre
Marienstraße 19/20, 10117 Berlin, Germany
Tel. +49-30-204586-87/-89
Fax +49-30-204586-88
[email protected], www.ieconline.de
Amtsgericht Berlin-Charlottenburg
HRB 115287 B
Geschäftsführerin: Hilka Leicht
About Yourself (*required fields only for homestay candidates)
Please use this part to tell ALI and your host family about yourself.
Your family (how many family members, occupations, ages): _________________________
_________________________________________________________________________
_________________________________________________________________________
Your home and your city:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Your occupation (student, teacher, etc):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Your hobbies and interests:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Have you ever lived in another country before? ___________________________________
If yes, where and for how long? ________________________________________________
_________________________________________________________________________
Campus Housing Preference
Do you prefer a roommate from your country?* □ Yes □ No
Contact Information
To whom should we send housing contract information?* □ Student
□ Agent/University
Agency/University Name (if applicable) ________IEC – International Education Center____
Email* [email protected]_________________________________________________
Fax ____030-204586-87_____________________________________________________
Airport Information
Do you want ALI Airport Pick-Up Service?* □ Yes
Available daily, you will be charged a $60 fee.
□ No
Seite 8/ 10
IEC Online GmbH
International Education Centre
Marienstraße 19/20, 10117 Berlin, Germany
Tel. +49-30-204586-87/-89
Fax +49-30-204586-88
[email protected], www.ieconline.de
Amtsgericht Berlin-Charlottenburg
HRB 115287 B
Geschäftsführerin: Hilka Leicht
Application Fee
Payment Amount
□ $175 (Application Fee)*
Method of Payment *Required Field
□ Credit Card (Please choose one)*
□Visa
□Mastercard
□Other
Card Number: ___________________________________________________
Expiration Date: _________________________________________________
*CVV: _________________________________________________________
*Please note: CVV is the 3 digit codes on the backside of your credit card – this is a
required field
Cardholder’s Name: ______________________________________________
Relationship to Student: ____________________________________________
Cardholder’s Signature: ____________________________________________
□ Cashier’s Check
Please make payable to: SDSU Research Foundation
□ Wire Transfer
Union Bank of California
6010 El Cajon Blvd
San Diego, California 92115
USA
ABA No.: 122000496
SDSU Foundation Account 0111-251906
Swift Code: BOFCUS33
Seite 9/ 10
IEC Online GmbH
International Education Centre
Marienstraße 19/20, 10117 Berlin, Germany
Tel. +49-30-204586-87/-89
Fax +49-30-204586-88
[email protected], www.ieconline.de
Amtsgericht Berlin-Charlottenburg
HRB 115287 B
Geschäftsführerin: Hilka Leicht
Important Information
I certify that I have read and agree to comply with all the ALI Housing Terms and Conditions.
□ Yes
□ No
I certify that I have read all the information regarding enrollment and I-20 processing and the
information I am providing in the application is true to the best of my knowledge.
□ Yes
□ No
By choosing to submit this form electronically, I agree that I am at least 18 years old and that
I bind and legally obligate myself to the same extent as I do by signing my name on a
printed paper version of this form.
□ Yes
□ No
The ALI requests your permission to include your name, program, and dates of attendance
in a public directory database.
□ Yes
□ No
Do you need special services to accommodate a physical, visual or learning disability?
□ Yes
□ No
If yes, please describe:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
I hereby permit College Contact to submit the information which I have provided on this form
to the ALI at SDSU via an electronic online application form created and maintained by the
ALI.
Student Signature
Date
__________________________________
____________________________________
Seite 10/ 10
IEC Online GmbH
International Education Centre
Marienstraße 19/20, 10117 Berlin, Germany
Tel. +49-30-204586-87/-89
Fax +49-30-204586-88
[email protected], www.ieconline.de
Amtsgericht Berlin-Charlottenburg
HRB 115287 B
Geschäftsführerin: Hilka Leicht