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The INTENSIVE ENGLISH LANGUAGE CENTER (IELC) at the UNIVERSITY OF NEVADA, RENO |
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Information : Type or Print Clearly |
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| Name (as listed on passport) | ||||
| Last Name (Family Name) | First Name | Middle Name | U.S Social Security Number (if known) | |
| Complete Current Mailing Address (Include City and Country): | ||||
| Email Address: | Telephone: Fax: | |||
| (Include Country Code and City Code) (Include Country Code and City Code) | ||||
| Complete Permanent Address (if different than mailing address): | ||||
| (Include City and Country) | ||||
| Gender: Male or Female | ||||
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| Applicant's Place of Birth: | Citizenship: | |||
| (City) (Country) |
(Country) |
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| Emergency Contact: Name: | Relationship: | |||
| Complete Mailing Address (Include City and Country): | Telephone: | |||
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Semester and Year you wish to enter: |
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Do you wish to apply for an F-1 visa ? Yes No
Please be aware that you must apply for an F-1 visa if your primary purpose for being in the U.S. is study.
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Are you currently attending another school in US ? Yes No
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Do you have family members who will accompany you ? Yes No
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Send me information about housing for : Apartment Dormitory
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| Please tell us how you learned about our program. | ||||||||||||||||
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| Financial Statement: This certifies that I will be financially responsible for | (Applicant's Name) | |
| during the time he/she is enrolled at the Intensive English Language Center at the University of Nevada, Reno.( Attach documentary evidence to indicate availability | ||
| of funds -a letter from the bank or financial institution stating that funds are available.) No I-20 will be issued unless this form is completed. | ||
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SIGNATURE (The person whose name is on the financial document please sign above) |
Relationship to Applicant |
Date |
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Print Name |
Telephone Number (Include Country Code and City Code) |
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| Mailing Address City Country |
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APPLICANT'S
CERTIFICATION: I certify the information provided on this application is accurate and understand that all required credentials must be directly submitted before an admission decision may be made. I accept complete responsibility for requesting that official transcripts of record be forwarded directly to the University from each school attended, whether credit was earned or not, and fully understand that all application materials are not returnable and cannot be reproduced. I authorize IELC to release my academic information to my parent or guardian/sponsor. Furthermore, I agree to abide by the rules and regulations of the University of Nevada, Reno. IELC retains all rights pertaining to the admission or non-admission of an applicant. If you enter the U.S. using our I-20, you are expected to attend at least one session in our program before transferring to another program. If you do not, you will be responsible for a $500.00 cancelation fee. |
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___________________________________________________________________________________________________ APPLICANT'S SIGNATURE Date |
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