Intensive English Program Center
Application Form
I am applying for the following session:
_____ Spring II 2016 _____Summer 2016 _____Fall I 2016 _____Fall II 2016 ____Spring I 2017
Applicant Information:
Family Name: ______First Name: ______Middle Name: ______
Sex: __ Male __ Female
Date of Birth: _____ Month / ______Day / _____ Year
Country of Birth: ______Passport Issued by: ______
Native Language(s):______
Applicant Contact Information
Mailing Address (include PO Box, Apt. #, Building #). If you are applying for an F-1 visa, please use your foreign mailing address.
Street Address:______
City: ______State: ______
Country: ______Postal Code: ______
Home Phone: ______
Cell Phone: ______
Email: ______
Emergency Contact Information
(Person to notify in case of an emergency)
Name: ______
Address: ______
Home Phone: ______
Work Phone: ______
Email: ______
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Immigration Status
Choose one:
_____ I am in the United States right now.
_____ I am outside the United States right now.
Choose one:
_____ I will apply for an F-1 student visa.
_____ I will transfer with an F-1 student visa.
____ I will change my visa status. My current visa status is ______.
_____ I do not require help with a student visa. I will study with a ______visa.
_____ I am a permanent resident/green card holder.
_____ I am a U.S. citizen.
How did you hear about KSU’s Intensive English Program?
___ IEP Website ___ Friend or relative ___ Former or current IEP student ___ KSU faculty/staff member
____ Other: ______
What are your plans after you attend Kennesaw State University’s IEP? For example, do you plan to pursue studies in an American university?
______
Do you plan to study full-time or part-time? _____ Full-time _____ Part-time
F1 visa students must study full-time. All others may study part-time or full-time.
If part-time, how many classes will you be taking? ______
If part-time, please circle the classes you are interested in:
ReadingWritingGrammarConversation & Pronunciation
Vocabulary & IdiomsListening & SpeakingTOEFL Preparation
F1 visa students go to next page.
All other students go to final page.
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For students who have or need an F-1 international student visa:
Are you transferring to the IEP from another school in the United States? ___ Yes ___ No
If yes, which school are you transferring from? ______
Address of school: ______
Contact telephone number of school: ______
Fax number of school:______
Accompanying Family Information (for F1 visa applicants only)
Complete the following if you have a spouse or child who will be accompanying you to the U.S. Please use back of form to note additional dependents. Supply the following information if you want to include your spouse or children on your I-20 form.
Family Name: ______First Name: ______Middle Name: ______
Relationship: ______
Date of Birth: _____ Month / ______Day / _____ Year
Country of Birth: ______
Important information for students who have or need an F-1 visa:
You will need an I-20 from the IEP. This is the document that allows you to get an F-1 from the American Embassy or American Consulate. To receive an I-20, you must have proof of holding $4,400.00 USD in a bank for estimated educational and living expenses in the U.S. For each additional family member you should have an additional $2000 in the bank for each eight weeks.
Please complete the next page and send the following documents with your application.
1) a completed financial statement showing a minimum of $4,400 (next page)
2) original financial statement showing a minimum of $4,400
3) a completed and signed affidavit of support (next page)
4) a completed immunization record
5) an application fee payable to Kennesaw State University (I understand that the application fee is
non-refundable and nontransferable.
Important information regarding mandatory health insurance for F-1 visa students:
All F-1 visa holders studying in the United States must have health insurance. Kennesaw State University requires its F-1 visa students to have health insurance with a certain amount of insurance coverage before the beginning of the semester. Additional information regarding health insurance will be sent after applicant obtains an I-20. Students planning to come on an F-1 visa, please sign the following:
I, ______, understand that all F-1 visa holders must have health insurance while in the United States. If accepted into the program, I will obtain the required health insurance.
______
Student’s Signature Month/Day/Year
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For students who have or need and F-1 international student visa:
IMPORTANT, PLEASE READ: Financial documentation must be submitted to show that you will have the necessary funds to cover all of your expenses while you study in the United States. These funds MUST be available to you. Studying in the United States is very expensive. While you are on an F-1 visa, you may not work off-campus, and jobs on campus are very limited. Additionally, there are no scholarships or loans available to Intensive English Program students. Please seriously consider whether you will have the funding available to you for all of your studies in the U.S. before you submit financial documentation and request an I-20 for an F-1 visa. Do not put yourself in the situation where you are in a foreign country without money to pay for your living and study expenses.
Financial Statement. Also submit a bank statement or official bank letter.$ ______ (Amount available to applicant, total must be equal or be greater than US $4,400.00
Where will you receive your support? Check one.
______My own funds
______My parents
______Other sponsor (specify) ______
______Sponsoring agency (specify) ______
Bank statements must show a minimum of $4,400 USD. If currency is not USD, the statement must indicate the type of currency.
The statement must be in English or Spanish, or be accompanied by a certified English translation.
The statement may be in the student’s name, or it may be from a sponsor. If the statement is from a sponsor, a sponsor letter or I-134 Affidavit of Support is required as well. Business accounts which show only the business name must be accompanied by a certified document that the sponsor owns the business or that the business is sponsoring the student.
Statements must have the account holder’s name, the bank name, and contact information such as phone, website, email, and/or address.
Statements must indicate available funds. Frozen accounts or accounts with restrictions or penalties will not be accepted. Retirement funds, salary stubs, business or property declarations will not be accepted.
The statements must me within six months of the program start date. Statements must show that the funds have been in the account for at least three months, or indicate an average balance. Large transfers of money not in the account for more than three months will require additional documentation explaining the source of the funds.
Clear, complete PDF scans are accepted. Incomplete scans or photos will not be accepted.
The IEP reserves the right to ask for an original copy if deemed necessary for verification.
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All students must read and sign the following:
1) I certify that all information on the application is true and accurate.
2) I understand that admission to KSU’s IEP is not the same as admission to a degree program at Kennesaw State
University. I must submit a separate application to a degree program at Kennesaw State University.
3) (For F-1 visa students only) I certify that the stated funds on the financial statement are available for my
educational expenses in the IEP at Kennesaw State University.
4) I understand that the United States Immigration and Naturalization Service will be notified immediately if I am
dismissed from the Intensive English Program or if I fail to attend.
5) I understand I will take an English placement exam in order to determine the appropriate level of English
language courses.
______
Student’s signatureMonth/Day/Year
Mail the completed form to:
Intensive English Program Center
Department of English
Kennesaw State University
440 Bartow Avenue, MD 2701
Kennesaw, GA 30144-5591
For questions:
470-578-2214
Or
Check list for applying to KSU’s IEP. Have you sent the following?
_____ I have completed all parts of the application.
_____ I have included the appropriate application fee (international money order or check) to the Intensive English Program.
_____ I have included documentation (original bank letter or statement) indicating a
guarantee of financial support.
_____ I have included a copy of my passport (for visa students) or other photo ID.
_____ I have included a completed immunization record (for F-1 visa students).