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| Family Name: |
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| Given Name: |
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| Other Name: |
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| Address (Line
1): |
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| Address (Line
2): |
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| City: |
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| State/Province: |
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| Country: |
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| Zip/Postal Code: |
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| Phone: |
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| Fax Number: |
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| E-mail
(Required):
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| Date of Birth: |
mm/dd/yy |
| Country of Birth: |
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| Country of
Citizenship: |
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Please indicate any
special needs:
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I would like to begin my studies on: | (Please
include Month, Day & Year)
(required) |
| I
would like to attend the program at: |
(required) |
| I am: |
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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/yy), Country of
birth / Citizenship and Relationship to You)
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| Type of
session preferred: |
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| Number of
sessions you intend to study: |
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| What
type of housing do you prefer? |
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| Do
you need an I-20 form to receive a student visa in order to attend one of the Agape
English Language Institute location? |
If YES, you must submit proof of financial support (U.S. $3,327.50 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 U.S.Embassy/Consulate
in your country. |
| Person
to Notify in case of an emergency: |
| Name: |
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| Address
(Line 1): |
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| Address
(Line 2): |
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| City: |
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| State/Province: |
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| Zip/Postal
Code: |
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| Business
Phone: |
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| Home
Number: |
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| Relationship
to You: |
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| I
certify that the information given above is complete and correct. I understand that
the application fee and any mailing fees are non-refundable. |
| 3.
Fees |
Please
review our Tuition and Fees. Payment by check accepted.
To apply, you can either:
- fill this form and submit it online, or
- print and mail this form with a application fee of U.S. $75 (non-refundable) to:
Agape English Language Institute
610 Pickens Street
P.O. Box 12504
Columbia, SC 29211-2504, USA
For further information, please contact info@aeliusa.com |
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Please press only once and be patient! Thanks!
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