Student Last (Family) Name:______________________ First (Given) Name: ______________________

Street Address: ____________________________________________________________________________

City: _______________________________ Country: ____________________ Postal Code: ___________

Phone: __________________________________ Fax: _____________________________________________

Date of Birth: MM/DD/YY____________ Passport #: _________________ Expiration Date: _________

Country of Birth: _______________________ Country of Citizenship: __________________________ 

Sponsor/Parent: ____________________________________________________________________________

Sponsor/Parent Address: ____________________________________________________________________

City: _______________________________ Country: ____________________ Postal Code: ___________

Sponsor/Parent Phone: ____________________________ Fax: ____________________________________

Expected Arrival Date:* _________________________ Destination after ALS: ___________________
*(Your entry into the U.S. must be no earlier than this date, nor later than 30 days
  after this date.)

Do you plan to take the standard 12 week course? ___________

Desired length of visa (12 months maximum): ________________

Have you attended English Classes? ________ If yes, state experience: ______________________

Language you plan to study: _________________

Please specify language specialization: (Business, Computer, General Conversation,

Import-Export, Legal, Medical, etc.) _______________________________________________________

Will you participate in our Student Homestay Program? ______________________________________