Intensive English Program Center at Kennesaw State University

Intensive English Program Center Application Form

Please read and complete all pertinent sections on the following application form.
***If you wish to complete the application by hand, the application can be printed in Word or in PDF format.

Part I: For all students:

I am applying for the following session:
Summer 2013 Waiting List Fall I 2013 Fall II 2013 Spring I 2014 Spring II 2014

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:
All applicants please complete. Please provide your foreign contact information if you are applying for a visa.

Mailing Address:	(include PO Box, Apt. #, Building #)
City:		State:
Country:		Postal Code:
Home Phone:
Cell Phone:
Email:

Emergency Contact Information:
(Person to notfiy in case of emergency.)

Name:
Address:
Home Phone:		Cell Phone:
Email:

Immigration Status:

Choose one:	I am in the United States right now.	I am outside of the United States right now.

Choose one:	I will apply for an F-1 visa. I will transfer with my student visa. I would like to change my visa status to F-1. I currently have this 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	Other: (Please specify: )
KSU faculty/staff member	Former or current IEP student

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? F1 visa students must study full-time. All other students may study full-time or part-time.	Full-time	Part-time
If part-time, how many classes will you be taking?
If part-time, please select the classes you are interested in:	Grammar	Listening and Speaking	Conversation and Pronunciation
	Writing	Reading	Vocabulary and Idioms

Part II: Complete Part II if you have or need an F-1 international student visa. All others scroll down to Part III :

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 (if applicable):
Complete the following if you have a spouse or child who will be accompanying you. Supply the following information if you want to include your spouse or child on your I-20 form.

Family Name:		First Name:	Middle Name:
Relationship:
Date of Birth:	Month / Day / Year
Country of Birth:

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 $4,000.00 USD in a bank for estimated educational and living expenses in the U.S. For each additional family member you should have an additional $2,000.00 USD in the bank.

Please complete the financial statement below, showing a minimum of $4,000.
If your funding is not coming from your own account, have your sponsor complete the I-134 Affidavit of Support ( link located on the application page of the website) or submit a sponsor letter..
Submit an original bank statement showing a minimum of $4,000. Bank letters should be written on official bank letterhead, in English (or have a certified translation attached), stamped and signed by a bank official. The letter should state name of the account holder, the date the account was opened, the currency type, and specifically state the amount that is currently in the account. If the funding is not coming from your account, submit an original bank statement from your sponsor.
IMPORTANT! Obtain two original bank statement letters. Send one original letter to the IEP. The other original letter is given to the U.S. embassy or consulate when you apply for a visa. Please send an official bank statement showing a minimum of $3,900 in order to show your eligibility for the I-20. An official bank statement letter is required before an I-20 can be created for you.

Financial Statement (must be completed for an I-20)
Total must be equal or greater than US $3900.00 USD.			$
Where will you receive your support? Check one:	My own funds	My parents
	Other sponsor, specify:	Sponsoring Agency, specify:
***If the student is being sponsored by his/her parents, a sponsor, or a sponsoring agency, the I-134 Affidavit of Support or a sponsor letter must also be completed.

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 complete the following:

I, , understand that all F-1 visa holder must have health insurance while in the United States. If accepted into the program, I will obtain the required health insurance.

Student's Name (In completing this box, I verify that this is my electronic signature):

Date: Month / Day / Year

Part III: All students must read and electronically 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) (For F-1 visa students only) I understand that F-1 visa students are required to obtain appropriate health insurance and certify that I will obtain it.
4) (For F-1 visa students only) 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 online English placement exam in order to determine the appropriate level of English
     language courses.

Student's Signature (In completing this box, I verify that this is my electronic signature):
Date: Month / Day / Year

Please include any comments you have regarding this application: