_____

         Career English Language Center
               for International Students
                                 Application Form

 ______
(Please type or print clearly)

Last Name: _______________________________________ First Name:_________________________________________

Date of Birth: month:________/day________/year____________

City of Birth:___________________________________ Country of Birth:_________________________________________

Country of Citizenship:____________________________________

U.S. Social Security Number, if any: ________________________________________ Sex: ____Male ____Female

Home Country Address:

___________________________________________________________________________________________________

_____________________________________________________________________Postal Code____________________

Send Admission Paper to (address):

___________________________________________________________________________________________________

_____________________________________________________________________Postal Code____________________

Home Telephone #: ______________________________________ Fax #: ______________________________________

Personal Email Address:_________________________________________________

____ Married _____ Single             If Married, will you bring your family? ____ Yes _____No

First and last name of spouse:________________________________________________________________________

Date of Birth:_________/_______/_________ Country of Birth: _____________________________________________

First and last name of child: _________________________________________________________________________

Date of Birth: ________/_______/_________ Country of Birth: _____________________________________________
(If you have more than one child, use a separate sheet of paper to supply the information)

Type of U.S. visa you have or hope to obtain: ___________________________________

Will you be transferring to CELCIS from another school in the USA? ____Yes ____No
****If YES, please send a photocopy of the I-20 you already hold****

Major area of study after English: _____________________________________________________

Educational Background:

_____ I have not finished high school
_____ I have finished high school (completion date: __________)
_____ I have finished ______ years of college or university
When do you wish to enroll in CELCIS? ____ Fall 20___
____ Spring 20___
____ Summer I 20___
____ Summer II 20___
I would like to live:

_____ in a residence hall (dormitory)
_____ on-campus apartment (limited to 4 persons)
_____ off campus
_____ Home Stay (www.azhomestay.com)

Indicate on the line below who will be financially responsible for you while you study in CELCIS at Western Michigan University AND their relationship to you.

Name:________________________________________________ Relationship:_______________________________

Please sign. This indicates your agreement to, and understanding of the following:

  1. The information given by me is true and correct.
  2. I understand that I must follow the regulations of CELCIS and WMU.
  3. I have read carefully the costs and am prepared to meet these expenses.
  4. I understand that the application fee and tuition deposit are non-refundable.
  5. I understand that a CELCIS I-20 does not mean that a visa will be granted.
  6. I understand that admission to CELCIS does NOT mean I am admitted to WMU.
Signature of student:________________________________________________ Date: __________________________

* * * * TO ENSURE A PROMPT RESPONSE PLEASE SUBMIT ALL DOCUMENTS IN ENGLISH * * * *

PLEASE INCLUDE:
1. The completed application form
2. If you are transferring from another U.S. school to CELCIS, a completed Transfer-In Form
3. A copy of your passport identification page
4. A completed Financial Guarantee and Support Statement Form
5. A completed Health History Form
6. An official bank statement from your financial sponsor showing proof that you will have $8,500 per semester (4 months) IN U.S. DOLLARS (Note: F-1 students enrolled in CELCIS are not eligible for financial aid)
7. A non-refundable $100 application fee, plus a non-refundable $100 tuition deposit - a total of (U.S.) $200. If you will have a scholarship from an agency that has an office in the United States, you may send us an official letter from your sponsor that is valid for use at WMU, which states the beginning and ending dates of validity, instead of the $100 tuition deposit.
8. A copy of your high school or college transcripts in English
CREDIT CARD PAYMENT INFORMATION:

Application and tuition deposit fees of US $200 (non-refundable) may be paid by credit card.
Please provide the following information to pay by credit card:

________ Yes, I authorize CELCIS to bill my credit card US $200 for application and tuition deposit fees. (non-refundable)

____ Master Card ____ Visa ____ Discover

Account Number: |___|___|___|___| |___|___|___|___| |___|___|___|___| |___|___|___|___|
Expiration month: |___|___| Expiration Year: |___|___|___|___|


RETURN TO:

Career English Language Center for International Students
0530 Ellsworth Hall
Western Michigan University
1903 W Michigan Avenue
Kalamazoo, Michigan 49008-5223 USA

PHONE: (269) 387-4800 FAX: (269) 387-4806
E-MAIL: celcis_info@wmich.edu
WWW: http://www.wmich.edu/celcis


© 2001 Career English Language Center for International Students, WMU
   All Rights Reserved