CLEVELAND STATE UNIVERSITY

INTENSIVE ENGLISH LANGUAGE PROGRAM

Please complete the entire application.

I want to begin to study during the following (please check one and add the year):

___Spring 201 ____ ___Summer session 201___ ___ Fall 201 ___

1. _______________________________________________________________________________

Last (family) name First name Middle name

(Print your name as it appears on your passport)

2. Permanent Mailing Address (in your country) 3. Permanent Telephone number, fax and/or e-mail

Please no P.O. Box

_________________________________________ Tel:_______________________________________

________________________________________ FAX:______________________________________

_________________________________________ e-mail______________________________________

4. Local Address (in the U.S.) if available. 5. If you are already in the U.S., what is your visa

________________________________________ status? (Circle one) Not applicable

B1 J1 F1

________________________________________ B2 J2 F2

________________________________________ Other (explain) ____________________________

6.Country of citizenship____________________ Alien Registration # _________________________

(passport issuance)

Country of birth _________________________ Do you need to change to a student visa? Yes No

7. Native Language __________________________ 8. Date of Birth _________________________

(Month/Date/Year) IELP students must be at least 18 years old.

9. Gender Male Female

10. Did you graduate from High School? Yes No Date ________________

Name of H.S. ________________________ (Month/Date/Year)

11. Do you need an I-20 document to request a student visa? Yes No

(Students requesting an I-20 must show financial support.

See other side of application.)

12. Are you transferring from another school in the US? Yes No

If yes, please give name and address of the school.

_____________________________________________ Dates of attendance:

______________________________________________ From __________ To ___________

13. Do you want to live on campus? Yes No

(Students living on campus must be at least 18 years of age. You must contact Residence Life for a separate application www.csuohio.edu/reslife)

14. Please give the name and address and/or telephone number of an emergency contact (friend or family), preferably in the United States.

________________________________________________________________________________

15. How did you learn about the Intensive English Language Program at Cleveland State University?

Friend/relative _____ Magazine _____ CSU Website _____ Internet advertising _____

Other (explain) _________________________________________________

16. Other information

Students who want to study at the Intensive English Language Program (IELP) must be 18 years of age by the first day of classes, non-native speakers of English and must complete the following application process. Complete the application form. Download the application form or apply online at www.csuohio.edu/cehs/departments/TE/ielp. Admission to the IELP does not guarantee admission to Cleveland State University. Note: While we have four levels of instruction at the IELP (elementary, low intermediate, high intermediate and advanced), there is no true beginner’s class at the IELP.

1. In addition to the application, please send a non-refundable application fee of U.S. $40 in a check or money order made payable to Cleveland State University or contact us about paying by credit card. Do NOT send credit card information by e-mail. Also send a photocopy of your passport.

2. If you are requesting an I-20 form to get an F-1 Student visa, send documents showing financial responsibility (see below) by mail.

3. If applying to the university, you can also send your most recent transcripts from your high school, college, technical school, university, etc. in English. ONLY IF APPLYING TO CLEVELAND STATE.

4. Mail everything to: English as a Second Language Program Or Fax to:

Cleveland State University (216) 687-5299

2121 Euclid Avenue, JH 314 (Please send check and

Cleveland, OH 44115 USA financial documents by mail.)

Express mail address: ESL Program, 2485 Euclid Avenue JH 314, Cleveland, OH 44115, USA

Statement of Financial Responsibility

All international students must show proof of financial support (tuition and living expenses) for the length of time they will study or at least one semester (see information below). Financial documentation must be sent in order for Cleveland State University to issue an I-20 form. The financial verification and I-20 must be presented at the U.S. Embassy or Consulate when applying for an F-1 Visa. Please have two original financial documents prepared:

- One for Cleveland State University and

- One to present to the U.S. Embassy or Consulate.

All documents must be original, dated and issued within the past year. You must have one or a combination of the following documents.


1. An original bank statement in your name showing the amount of funds available in U.S. dollars.

2. An original bank statement in your guarantor's name (sponsor or parent) that indicates the amount (in U.S. dollars) available accompanied by a letter of confirmation from the guarantor of his/her intention to provide support. The bank statement MUST indicate a minimum amount held in the account on bank stationary with a telephone and FAX number for the branch and street address.

3. An Affidavit of Support (I-134 form) if your sponsor is a US citizen or Permanent Resident of US. The form is available at our office or downloaded at http://uscis.gov/graphics/formsfee/forms/index.htm Item #11 must be completed indicating the sponsor's financial intentions.

4. A letter from your guarantor's employer and a letter from the guarantor confirming his/her intention to provide support and the amount he/she plans to provide.

5. A letter of support from your government or sponsoring agency that shows the amount available and additional provisions, such as health insurance coverage. Please provide a signed copy of the award letter with billing instructions. You should also send a copy to the Cleveland State University Treasury Services office once you arrive in order for the billing to take place.