IELI Application and Affidavit of Support

IELI Application Form

Instructions: Type all information and then print out the completed form.

Information about the student Family name:

Given name:

Date of birth:

Country of birth:

Citizenship:

Gender:
Male Female

Marital status:
Single Married

Address (I-20 will be sent
to this address):

Email:

Telephone:

Fax:

Academic term you plan to begin
your studies Select a term:
2013 Summer 10-week term (May)
2013 Fall 15-week term (August)
2014 Spring 15-week term (January)
2014 Summer 10-week term (May)
2014 Fall 15-week term (August)
2015 Spring 15-week term (January)

Note: If you are applying for "English only," you must also complete the IELI Affidavit of Support.

Dependents If you are bringing your
spouse and/or children, provide the
following information: Name of spouse:

Spouse's date of birth:

Name of first child:

First child's date of birth:

First child's gender:
Male Female

Name of second child:

Second child's date of birth:

Second child's gender:
Male Female

For additional children, please attach
a separate sheet.

Parent / guardian information Name of parent or guardian:

The person named just above is my:
Parent Guardian

Parent / Guardian Address:

Parent / Guardian Email:

Parent / Guardian Telephone:

Parent / Guardian Fax: