AEP Application Please complete sections 1-5 of this application. Please answer all questions truthfully. Download the Student Application Instructions and Checklist to see the steps to successfully complete this application. Section 1: Personal Information Student First Name Student Middle Name Student Family Name GenderMaleFemale Birthday01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyear Native Language Country of Birth Country of Citizenship Home Phone Cell Phone E-mail Home Country Street Address City Province/Territory Country Emergency Contact First Name Middle Name Last Name Home Phone Cell/Work Phone Email Please choose ONE of the following options below and fill in the information for that option. 1. This is my first time studying in the U.S. I need an I-20 form so that I can obtain an F-1 visa. My passport number is Expiration date Note: There must be at least 6 months validity remaining on your passport. 2. I am transferring from another school. I will need a new I-20 from ELI. My SEVIS ID is Current School Name Foreign Student Advisor's Name Note: You will also need to fill out ELI's Transfer-in form. This form will be emailed to you by the DSO. 3. I currently have a different visa and need to change my status to F-1. Visa type Current Visa Expiration Date01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyear Note: Please complete ELI's Change of Status form. M-1 students cannot change their status while in the U.S. If you have an M-1 visa, you must depart the U.S. and apply for an F-1 visa. 4. I do not need a visa. Please explain Section 2: Dependents Please fill out this section if you have dependents that will also need an I-20 form. F-1 students bringing children or a spouse must provide financial documentation (such as a bank statement) which will show the student's ability to support the family. The bank statement must show there are sufficient funds to pay $6,300 for their spouse per year, and $4,300 for each child per year. Dependent #1 D1. First Name D1. Middle Name D1. Family Name D1. Country of Birth D1. Country of Citizenship D1. Date of Birth D1. Visa Type D1. Visa Expiration Date 01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyear D1. Relationship Select valueSpouseChildOther If other, please explain Section 3: Eligibility Information Please answer the following questions truthfully. 1. Are you at least 17 years of age? YesNo 2. Have you graduated from High School?YesNo If No, What is your expected graduation date? 3. Are you able to provide your official high school transcript/diploma?YesNo 4. Did you receive a grade of C or higher in each subject?YesNo 5. Did you plan on attending a college or university in the United States?YesNo 6. Are you willing to attend various cultural events/activities about U.S. culture?YesNo What is your desired start date?Summer: May 22, 2017Fall 1: August 14, 2017Fall 2: October 16, 2017 Section 4: Financial Information The English Learning Institute requires all students of the Academic English Program to pay for their tuition, room and board in full, before the start of each semester. Please fill in the following information regarding your ability to pay for the tuition and additional costs associated with our Academic English Program. Please note that textbooks are not included in the tuition. Please select one of the following:I will be supporting myself as a student at the English Learning Institute (Proceed to Section A)I will be receiving support from a financial sponsor (Proceed to Section B) A. Self-Supporting Students Tuition, Room, and Board InformationStudents need to show proof that they have enough funds to cover the total for 4 semesters of tuition, room, and board. Please keep in mind that we do not have on-campus work opportunities for our students to work, so make sure that any funds you mention that will be used to pay for your expenses will not include any expected work experiences here during your program start and end date.Please submit a bank statement that shows a current balance of $50,000 or more, plus the necessary funds for the dependents (if applicable), $6,300 for spouse, $4,300 per child. The bank statement that is submitted must be on the bank letterhead and signed by an official. I confirm that I will have the necessary funds to cover all costs while I study in the USA. I have attached supporting documentation to support my claim. I agree to pay for all the semesters during my program start and end date. I certify that the information I have provided on this form is accurate. I understand that providing any false information or concealing important information regarding my finances will result in dismissal from the program or the denial of application to ELI. Signature Today's Date01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyear B. Students with Financial Assistance (this section should be filled out by the financial sponsor(s)) Tuition, Room, and Board InformationThe Financial sponsor(s) need to show proof that they have enough funds to cover the total for 4 semesters of tuition, room, and board. Please answer the questions below. Please describe your relationship to the studentParent(s)Guardian (other than parents)Other If Other, please explain Please provide your address Sponsor Country of Citizenship Native Language Email Address Phone Number Please submit a bank statement that shows a current balance of $50,000 or more, plus the necessary funds for the dependents (if applicable), $6,300 for spouse, and $4,300 per child. The bank statement that is submitted must be on the bank letterhead and signed by an official. I confirm that I have the necessary funds to cover all costs while the student studies in the USA. I have attached supporting documentation to support my claim. I agree to pay for all the semesters during the student's program start and end date. I certify that the information I have provided on this form is accurate. I understand that providing any false information or concealing important information regarding my finances will result in dismissal from the program or the denial of application to ELI. Signature Today's Date 01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyear Documents: Please submit the following documents with this application. Bank Statement Copy of Passport Photo page Transcript Section 5: Agreement and Signature By submitting this application, I affirm that the information provided is true and complete. I understand that if I am accepted as a student, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. Application Fee $ How did you hear about ELI?Please choose oneStudy USA WebsiteSearch EngineELI Website or Social MediaFormer StudentELI FlyerRecuiter/AgentOther If Other, please explain: SubmitReset This post is also available in: Vietnamese Arabic Spanish Chinese (Simplified) Korean Italian