QC/ELI Path International Admissions Application

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1 QC/ELI Path International Admissions Application I am applying for the QC/ELI Path Graduate: Must complete two applications: (1) This application and (2) QC/ELI Path Graduate Admissions Application. 1. Name (as it appears on your passport): Family name: Given name: 2. Student Address (required): _ 3. Addresses A. Permanent Address. This must be the address of the STUDENT. Required. PerAd B. ma Present dre Mailing Address (if applicable). nenss Mai lin g (if applicable) (required) Ad dre Press 1

2 C. United States Address (if known). U.S.A. Address (if known) D. Agent Address (if applicable) Agent Name: Agency Name: Agent Address (if applicable) Agent Phone Agent 4. Place of Birth: _ 5. Country(ies) of Citizenship: 6. Country of Residence: 7. Date of Birth: / / 8. Sex: Female Male 9. Marital Status: Single Married 10. Have you taken the TOEFL or IELTS? Yes No If yes, type of TOEFL: Paper _Computer-based Internet Date Taken: Score: 11. Highest Degree Completed: High School University (Undergraduate) University (Graduate) 12. Expected semester and year of enrollment: Year: Check: Fall Spring Summer I Summer II 13. How long do you plan to study in the Intensive English Language Program? (The average length of study is 1 year.) 1 year (Recommended) Fall only (15 weeks) Summer only (11 Weeks) Spring only (15 weeks) 14. Date you expect to arrive in the United States: / / 2

3 How did you learn about QC/ELI Path? Please check one.. A friend or family member A school counselor An agent A StudyUSA Magazine The ELI/ESL Brochure A newspaper: Which newspaper? The ESL postcard The Internet (where/how?) ELI website Queens College website Google ad USA Education Guides Study USA.com/esl.com _ another site: Which site? I did a general search: What words did you use? Estimated Expenses for one Year: 1 year Tution: $5, (2 Semesters) Living expenses: $17,613 Total: $23,611 Dependents: o Child: $5,000 o Spouse: $7,500 Checklistfor the QC/ELI Path InternationalApplication: Application: Complete, signed, and dated QC/ELI Path Student Visa Application Affidavit of Support form: Completed Bank Statement Proof of Income Copy of Passport Non-refundable fees: Undergraduate: A $180 USD Money Order made out to Queens College OR Graduate: A $180 USD Money Order made out to Queens College. No cash is accepted.no cash is accepted. Mailing Address: QC/ELI Path International Student Advisement Office English Language Institute Kissena Hall, Room Kissena Blvd., Flushing, NY USA I confirm that the information on this application is true and complete. I understand that I am required by the United States Government to have the necessary funds for the program for which I am registering at this university. I have the required funds available. Signature of Applicant: Date: 3

4 QC/ELI Path International Admissions Affidavit of Support This form must be completed by the person (sponsor) who will provide the student with full or partial support and/or room and board during the student s course of study at the City University of New York. Instructions: Complete items 1 through 6 if you are a sponsor providing financial support: Complete items 1 and 7 if you are a sponsor providing room and/or board. If the financial sponsor is different than room/board sponsor, please fill out two different forms. Sponsor Information 1. I,, citizen of Sponsor (family name, given name) country(ies) Am residing at Telephone number/s _ 2. I am employed with _ Name of employer employer s telephone number located at I receive an annual income of $ (in U.S. dollars) from this employment.* *Attach a current salary confirmation statement written by that employer or verification of annual income for self-employment or retired individuals. The employer statement or verification of annual income must be written in English or come with a certified translation. Certify the Following: 3. I have $ (in U.S. dollars) on deposit with: employer s telephone number Bank address: NOTE: Attach bank officer s statement of account history. 4

5 4. I currently support # persons (number of people including myself.) Our total annual income is $ (in U.S. dollars). Our total family expenses are $ (in U.S. dollars). I sponsor # individuals for immigration in addition to this affidavit. Student Support Information: 5. This affidavit is executed on behalf of Student ( family name, given name) who was born on. S/He is my. relationship to sponsor 6. I hearby certify that I am willing, able and do commit to provide Student (family name, given name) With an annual amount of $ (in U.S. dollars) for his/her tuitions, fees, and/or living expenses during the entire program of study at the QC/ELI Path program until. Month/date/year of when the sponsorship is expected to terminate Room and Board Support Information: 7. I hearby certify that I am willing to provide Student (family name, given name) with Room only in my home at the address: valued at $7,500.* Full room in my home at the address above and board: valued at $10,000* *Note that this value cannot be included in any amount of support being provided in #6 above. Attach a copy of your lease or deed or copy of a statement from your landlord. By signing my name to this affidavit, I certify that the information above is a correct statement of my agreement to sponsor the student herein named. Signature of sponsor: Print name: date:_ 5

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