Given Name	*
Family Name	*
Home Address	*
Address (cont.)
P.O.Box
City	*
State (if USA)	*
Zip/Postal Code
Country	*
Work Phone
Home Phone
FAX
E-mail	*

Gender:

Male Female

Country of Birth

*

Date of Birth (Month/Day/Year)

*

Country of Citizenship

*

Social Security Number (If None, leave Blank)

Date of secondary school graduation (year)

*

Current Immigration Status

Requesting I-20 Student Visa (F-1) Visitor Visa (B-1) Sponsored (J-1) US Resident Alien (Green Card Holder) U.S. Citizen Other(Refugee, etc)

Explain visa request

I want to attend the following time

Summer I Summer II Fall I Fall II Spring I Spring II             Year    *

Which ALI program would you like to attend

EAP (English for Academic Purposes) ALI-Provisional ALI-Bridge English for Specific Purposes English for Visitors

Yes No

 

What undergraduate major do you want to study at IUP?

How many years have you studied English?

 
1 2 3 4 5 6 7 8 9 10 11 12 13 14

What is your most recent TOEFL score

IBT  CBT   PBT

Are you applying to another university in the US?

Yes No

How did you learn about the ALI at IUP?

IUP
Friend
Internet
Advertising
School
Other (Indicate below)

 

Housing Options

NONE On-Campus Dormitory Off-Campus Apartment Homestay  

Is there anything you would like us to know?