Agape English Language Institute
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Application for Admission

1. Personal Information
Family Name*
Given Name*
Other Name
Address (Line 1)*
Address (Line 2)
City*
State/Province
Zip/Postal Code
Country*
Phone*
Fax Number
E-mail*
Gender*


Date of Birth* (MM/DD/YYYY)
Country of Birth*
Country of Citizenship*
Please indicate any special needs

2. Registration
I would like to begin my studies on*
I would like to attend the program at*


Please complete the following information if you have a spouse and/or children who will accompany you

Please indicate name, date of birth (MM/DD/YYYY), country of birth/citizenship and relationship to you
Type of session preferred
Number of sessions you intend to study
What type of housing do you prefer?

Do you need an I-20 form to receive a student visa in order to attend Agape?*

If YES, you must submit proof of financial support (3,377.50 USD per 9-week session, plus additional money for personal expenses) before our school can issue the I-20 form you will need to obtain a student visa from the US Embassy/Consulate in your country.

Person to Notify in Case of an Emergency
Name
Address (Line 1)
Address (Line 2)
City
State/Province
Zip/Postal Code
Business Phone
Home Number
Relationship to You

How did you learn about Agape English Language Institute?
Which one?
Which link?
Who?
Who?
Please specify

3. Fees

Please review our Tuition and Fees.

To complete your application, please pay the 75 USD Application Fee (non-refundable) via bank check, Western Union, Money Gram, or Wire Transfer (the wire transfer fee is 25 USD). You may mail your fee to

Agape English Language Institute
610 Pickens Street
P.O. Box 12504
Columbia, SC 29211-2504
USA

For further information, please contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it

4. Submit Application!

I certify that the information given above is complete and correct. I understand that the application fee and any mailing fees are non-refundable.


Please press only once and be patient! Thanks!