University at Albany – State University of New York
Intensive English Language Program Application Form

Please carefully fill out the following information. We will use this information to create your University at Albany and SEVIS records. Be sure that all information is accurate and that all statements are true.

* Required

Please verify the 4-Week session you want to apply for.Click here to see session dates.*
I am applying for the following session:
Choose an item.

FAMILY NAME exactly as it appears on your passport:*
Click here to enter text.

GIVEN NAME exactly as it appears on your passport:*
Click here to enter text.

MIDDLE NAME exactly as it appears on your passport:
Click here to enter text.

PERMANENT ADDRESS in your country. (This must be the home address of the student.)*
Click here to enter text.

PHONE NUMBER (Including country code):
Click here to enter text.

EMAIL ADDRESS:*
Click here to enter text.

AGENT ADDRESS (if applicable):
Click here to enter text.

AGENT PHONE NUMBER:
Click here to enter text.

AGENT EMAIL ADDRESS:
Click here to enter text.

COUNTRY OF BIRTH:*
Click here to enter text.

COUNTRY OF CITIZENSHIP:*
Click here to enter text.

DATE OF BIRTH:*
Click here to enter a date.

GENDER:*
☐Male
☐Female

HIGHEST DEGREE COMPLETED:*
☐High School
☐University (Undergraduate)
☐University (Graduate)
☐ Other Click here to enter text.

Do you need an I-20 for an F-1 Student Visa?*
☐ Yes
☐ No

How long do you plan to study at the Intensive English Language Program? *
☐One 8-week session
☐One semester (two eight-week sessions)
☐ One year
☐Other: Click here to enter text.

Approximate date you expect to arrive in the U.S.:
Click here to enter a date.

Do you plan to remain in the U.S. for academic study after completing your program at the IELP?*
☐Yes
☐No
☐Unsure

Are you transferring FROM another school in the U.S.?*
☐Yes
☐No

TRANSFER INFORMATION
Answer this section ONLY if you answered YES to the previous question.

Name of the SCHOOL and PROGRAM that you are transferring from?
Click here to enter text.

PHONE NUMBER of the school you are transferring from:
Click here to enter text.

EMAIL ADDRESS of the school you are transferring from:
Click here to enter text.

Do you understand that you must send a current transfer form?
☐Yes

How did you learn about IELP?
Click here to enter text.

FINANCIAL STATEMENT

The United States Government requires all foreign students applying for an F-1 Visa (student visa) to furnish proof of sufficient funds for the cost of their studies and living expenses in the United States.

To receive an I-20 form, you must emailor mail a statement from your bank on original letterhead to:

Intensive English Language Program
Science Library G-40
University at Albany
1400 Washington Ave
Albany, NY 12222 U.S.A.

Email:

Amount Required for F-1 Students:

  • $3455 for the requested session.
  • $2000 required for each dependent I-20.

Do you understand that you are required by the United States Government to have the necessary funds for the program for which you are registering at this university?*
☐Yes

Do you (or your sponsor) have the required funds available?*
Your sponsor is the person who will support you financially while you study in the U.S.
☐Yes
☐Other: Click here to enter text.

I certify that I am aware of the costs for the Intensive English Language Program at the University at Albany, State University of New York. I further certify that I fully understand that I must pay tuition on the first day of the session. Room and board, comprehensive fees, and medical insurance are payable to the University after my arrival.*
☐ I, the student, so certify.
☐I, the sponsor, so certify.

Who will support you financially?*
You (the student) or your sponsor must provide a bank statement.
☐I, the student, will support myself.
☐My sponsor will support me.

SUPPORTING SPONSOR INFORMATION
Answer this section ONLY if you answered MY SPONSOR WILL SUPPORT ME in the previous question

NAME of SUPPORTING SPONSOR
The sponsor is the person who will financially support the student. It could be a parent or another sponsor.
Click here to enter text.

ADDRESS of SUPPORTING SPONSOR
Click here to enter text.

DEPENDENT INFORMATION
Do you wish to bring a dependent (spouse/child) with you to the U.S.?*
A separate I-20 form is issued for each dependent. There will be a $30 charge for each dependent. Please include all extra charges with your application fee.
☐Yes
☐No
☐Unsure

Fill out this section ONLY if you answered YESto the previous DEPENDENT question.

  • Carefully fill out all information for each dependent.
  • A separate I-20 form is issued for each dependent.
  • There will be a $30 charge for each dependent.
  • Please include that amount in your application fee.
  • Be sure to verify $2000 for each dependent in your financial statement.

*All information is required for each dependent.

Dependent / Family Name / Given Name and Middle Name / Date of Birth / Country of Birth / Country of Citizenship / Gender / Relationship To Student
#1 / Click here to enter text. / Click here to enter text. / Click here to enter a date. / Click here to enter text. / Click here to enter text. / Choose an item. / Choose an item. /
#2 / Click here to enter text. / Click here to enter text. / Click here to enter a date. / Click here to enter text. / Click here to enter text. / Choose an item. / Choose an item. /
#3 / Click here to enter text. / Click here to enter text. / Click here to enter a date. / Click here to enter text. / Click here to enter text. / Choose an item. / Choose an item. /

FINAL INSTRUCTIONS

Step 1: Save this form and email or mail it to IELP.

Step 2: Email or mail an original statement from a bank that verifies that you, your sponsor, or your sponsoring organization have sufficient funds to pay all of your expenses.

Step 3: Email or mail a photocopy or scan of the first page of your passport so that we can verify the spelling of your name.

Step 4: Mail the $130 application and Express Mail fee in the form of a money order payable to "University at Albany" to the following address:

Intensive English Language Program
Science Library G-40
University at Albany
1400 Washington Ave
Albany, NY 12222 U.S.A.

Email:

Telephone: (518) 437-5040
FAX: (518) 591-8171

YOUR APPLICATION WILL NOT BE COMPLETE UNTIL WE RECEIVE THE BANK STATEMENT, PASSPORT COPY AND THE APPLICATION FEE.

When we receive your application, financial statement, passport copy and application fee, we will send you an I-20 Form (Immigration and Naturalization Certificate of Eligibility). You will need the I-20 Form in order to receive an F-1 student visa at the U.S. Consulate/Embassy in your country.

Special instructions:

If there are no special instructions, we will mail the acceptance packet to your home address. If you'd like the acceptance packet mailed to a different address, please type the name and address below:
Click here to enter text.

Thank you for applying to the University at Albany Intensive English Language Program. We look forward to seeing you soon.