IEP ADMISSION APPLICATION (2 pages)

     **Print this form using a non-proportional (e.g. Courier) font
                      Please print your answers! 
 
NAME:____________________________________________________________________       
        Last(family)name             First name           Middle Name
 
ADDRESS:_________________________________________________________________
                               Street/P.O. Box

        __________________  ______________________  _____________________          
          City                    Country                Postal Code
 
COUNTRY OF CITIZENSHIP:______________   COUNTRY OF BIRTH:________________
 
BIRTHDATE:______/____/_____                    MALE  /   FEMALE
          Month  Day  Year                        circle one
 
PHONE NUMBER _______________________    FAX NUMBER_______________________

	EMAIL ____________________________________
	
               >>>>  MARK THE SESSIONS YOU WANT TO STUDY: <<<<
                       (each session is 7 weeks long)

				 ___ 10/11/2007       
                             	 ___ 01/02/2008            
                             	 ___ 02/21/2008         
                             	 ___ 04/30/2008      
                            	 ___ 06/19/2008        
                             	 ___ 08/27/2008         
          		    	 ___ 10/16/2008
	

WILL YOU BRING YOUR SPOUSE? NO/YES
 
WILL YOU BRING CHILDREN? NO/YES         HOW MANY CHILDREN? ______

     SPOUSE and CHILDREN'S INFORMATION:
          Name         Date of   Country of  Country of    Relationship
                        Birth      Birth     Citizenship    (husband,
                                                             wife, son,
                                                             daughter)
     ________________ _________ ____________ _____________ ____________
     
     ________________ _________ ____________ _____________ ____________
     
 
WILL YOU APPLY FOR A STUDENT VISA? NO/YES
 
DID YOU FINISH HIGH SCHOOL? NO/YES     WHEN DID YOU GRADUATE? __________
 
INDIANA UNIVERSITY IDENTIFICATION NUMBER (if you have one):_____________

WILL YOU NEED HANDICAPPED SERVICES? NO/YES   WHAT TYPE?_________________

WHERE DID YOU HEAR ABOUT THE INDIANA UNIVERSITY INTENSIVE ENGLISH PROGRAM?

_________________________________________________________________________

IF YOU ARE IN THE UNITED STATES, PLEASE ANSWER THE FOLLOWING QUESTIONS:


WHAT TYPE OF VISA DO YOU HAVE?

     ____F/Student (please send us a copy of your I-20 when applying)

     ____J/Exchange   ____B/tourist   ____Other:_________________________

 
ARE YOU SPONSORED BY A GOVERNMENT OR CORPORATION?    NO/YES
            
	IF YES, DO YOU HAVE PERMISSION FROM YOUR SPONSOR TO TRANSFER 
	TO OUR PROGRAM?               NO/YES
	
	SPONSOR'S NAME___________________________________________________
 
 
Before we can send you an I-20 visa document, you must send us ALL of the
following items:
1. This completed application form
2. One passport-type photograph;
3. A $100.00 application fee in U.S. funds, payable to Indiana University
   (this fee is non-refundable)
4. Proof that you have financial support while you attend our program (an
      original bank statement AND letter of support or a financial 
      guarantee from your government)


		MAILING ADDRESS AND PHONE NUMBER 
	  (only if different from student's address:)
	
	____________________________________________________
	
	____________________________________________________
	
	____________________________________________________
	
	

Complete this form and fax to us at:  812 - 855-5605
                            -or-
mail, along with enclosures and $100 application fee, to:

        Application
        Intensive English Program
        Memorial Hall 313, 1021 East Third Street
        Indiana University
        Bloomington, Indiana 47405-7005
        U.S.A.