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INTENSIVE ENGLISH PROGRAM  
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On-line Application Form :: Application

IMPORTANT: If your browser does not support online forms, please download a printable application.

      Click here for PDF version or
      Click here for MS Word

NOTE: Fields marked with * are required.

PERSONAL INFORMATION (All fields are required):
Name:
Last or Family Name*
First Name(s)*
Middle Name
Permanent Home Country Address:
Street/P.O. Box*
City*
State
Postal Code
Country*
Country of
Citizenship:*
Country of Birth:*
Birthdate*
MonthDateYear
Gender* Male              Female
Email*
Phone number:*
Fax number:
Highest Educational Level Attained* High School
Undergraduate Degree
Graduate/Professional Degree
Other (Please explain)   


STUDY PLANS: Mark the session in which you want to begin your studies (each session is 7 weeks long)*

January 7, 2009 January 6, 2010 January 5, 2011
February 26, 2009 February 25, 2010 February 24, 2011
May 6, 2009 May 5, 2010 May 4, 2011
June 25, 2009 June 24, 2010 June 23, 2011
August 26, 2009 August 25, 2010 August 24, 2011
October 15, 2009 October 14, 2010 October 13, 2011
How many sessions do you plan to study in the IEP?
(your estimate—we know it might change)*


SPONSOR INFORMATION

Who will pay for your studies at the IEP?
 Self-sponsored
Family-sponsored
Government Sponsor
Other Organization
Sponsor's Name:

If you are being sponsored by a friend, a relative or yourself, we need:

  1. ORIGINAL bank statement of the person who will support you (estimated in U.S. funds).
    If this statement is YOURS, then this is all we need for support;
  2. If the statement is NOT yours, we also need an ORIGINAL letter from the person who will support you.  This letter must include:
    1. the length of time that this person will support you while you are in the U.S.;
    2. their name and address; and,
    3. their signature.

If you are being sponsored by a government or corporation, we need:

  1. ORIGINAL financial guarantee letter covering English language training with our name on it; and
  2. a billing address in the United States for tuition and other fees.


IMMIGRATION INFORMATION

What Immigration status will you have? (choose only one)
    Student Visa
    Non-student Visa--H, L, R, etc. (please specify)
    U.S. Citizen
    U.S. Permanent Resident
    Other (explain)
If you are already in the United States, what type of Visa do you currently have?
    F/Student - (Please send us a copy of your I-20 when applying.)
    J/Exchange
    B/Tourist
    Other:
Are you a transfer student? Yes              No
If Yes, What is the name of your current school?


Do you plan to bring family members with you? Yes              No

Dependent Information (Spouse and Children), if you will bring them.
NameDate of Birth
month/date/year
(eg. 3/25/2009)		 Country of BirthCountry of CitizenshipRelationship
(husband, wife,
daughter, son)

NOTE: If you have additional dependents, please include it in the comments field below.



MISCELLANEOUS INFORMATION

Will you need handicapped services? Yes          No
What type?
How did you hear about the Indiana University Intensive English Program?
Any additional comments or questions


APPLICATION REQUIREMENTS

Before we can send you an I-20 visa document, you must send us ALL of the following items:

  • This completed application form
  • A $100.00 application fee in U.S. funds, payable to Indiana University (this fee is non-refundable)
  • Proof of financial support while you attend our program (an original bank statement AND letter of support or a financial guarantee from your government)
  • Photocopy of picture page in your passport

If you want to pay the application fee by credit card [Visa, Mastercard, Discover, American Express], please use the following link:  https://quikpayasp.com/iu/commerce_manager/payer.do?orderType=BL~SLS~iep.


Mailing Address for I-20 (if different from address above):
Address (line 1)
Address (line 2)
Address (line 3)
Address (line 4)
Address (line 5)
DELIVERY PHONE NUMBER (required for express mail):*