Language Institute. WESTWOOD HOLYWOOD

MLI started in 2002. Since then, we have educated thousands of students from over 50 countries. Our main campus is located in the heart of Westwood, the home of UCLA. In the beginning we offered ESL and programs only, but since then we ve added Business English, Conversation,, GRE /GMAT and. Mentor Language Institute offers English as a Second Language (ESL), English for Academic Purposes (EAP), and English for Specific Purpose (ESP) instruction that meets the needs of students and empowers them with a lasting ability to use English successfully in their academic, professional and personal pursuits. Language Institute WESTWOOD 10880 Wilshire Blvd., #122 Los Angeles, CA 90024 E-mail: info@mliesl.edu Phone: 310-887-0777 HOLYWOOD 7080 Hollywood Blvd., #314 Hollywood, CA 90028 E-mail: hollywood@mliesl.edu Phone: 323-870-7102 www.mliesl.edu

Westwood is a vibrant, unique neighborhood located on the west side of Los Angeles. Westwood is famous for being the home of UCLA. It is a very fun and popular area for students since there are a lot of university students and many shops, restaurants and safe places to hang out. The students at our Westwood campus tend to pursue higher education at colleges, universities or graduate schools after attending MLI. That s why our test preparation program is so popular and is offered in the morning, afternoon and evening! Hollywood is well known as the heart of the entertainment industry. The Oscars take place at the Dolby theater just 4 minutes from our Hollywood campus, which is located at Hollywood & Highland. It takes only 5 minutes to walk to/from the Hollywood/Highland subway station. Many events such as movie premiers or opening ceremonies are also hosted here. Our Hollywood students tend to be interested in aspects of the entertainment such as dance, music, acting, filming, yoga and so on.

ESL/ Conversation Programs 2019 SCHEDULE Test Preparation Programs Westwood MORNING BEG. Track 1 BEG. Track 2 INT. Track 1 INT. Track 2 H. INT. Track 1 H. INT. Track 2 ADV. Track 1 ADV. Track 2 9:00 am 9:50 am 10:00 am 10:50 am 11:00 am 11:50 am 12:00 am 12:50 pm CONV. INT. 4 days/wk LUNCH BREAK + CONV. ADV. 4 days/wk M,W,F 2:50 pm BEG. 9:20 am 9:30 am 10:20 am 10:30 am 11:20 am INT. Track 2 HIGH INT. ADV. Track 1 10:05 am 11:05 am 11:20 am 12:20 pm LUNCH BREAK AFTERNOON 1:00 pm 2:00 pm 2:10 pm 3:10 pm CONV. INT. 3:20 pm 4:20 pm CONV. ADV. + M,W,F T,Th 1:00 pm 2:00 pm 2:10 pm 11:05 am 12:10 pm 12:20 pm 1:15 pm 4 days/wk 3:10 pm 3:20 pm 4:20 pm 3:35 pm 4:40 pm 4:50 pm 9:50 am 11:15 am 3:45 pm GRE/ GMAT 2:30 pm 8:50 am 11:30 am 12:20 pm INT. Track 1 GRE/ GMAT 5:10 pm 8:30 am 4:10 pm Hollywood GRE/ GMAT 4:00 pm 4 days/wk 2:40 pm 10:10 am GRE / GMAT 1:30 pm 3:00 pm 4:20 pm MORNING T,Th 10:15 am 10:00 am 12:30 pm 10:00 am 11:30 am 1:50 pm 3:15 pm 5:15 pm 9:00 am 11:15 am 2:10 pm 4:10 pm 1:00 pm 3:05 pm 2:00 pm 9:00 am AFTERNOON * Teachers rotation is subject to change. ** The schedule is subject to change. *** The class is opened based on the number of the enrollment. 5:45 pm 4 days/wk: Monday through Thursday : Monday through Friday

SCHOOL PRICES 2019 Program ESL TM GRE /GMAT Business Communication Business English plus Conversation Price per week 1wk-4wks 5wks -12wks 13wks-24wks 25wks-36wks 37wks + $270 $220 $200 $192 $185 ex) ESL Program for 12 wks: $220/wk x 12wks = $2,640 Option or ESL+ + TIP Program Price per week 1wk-4wks 5wks -12wks 13wks-24wks 25wks-36wks 37wks + $321 $265 $255 $243 $237 ex) ESL + for 24 wks: $255/wk x 24wks = $6,120 Price per week Option Program 1wk-4wks 5wks -12wks 13wks-24wks 25wks-36wks 37wks + ESL+ ESL+ Business Communication ESL+ Business English plus ESL+ Conversation ESL+ GRE / GMAT + Business + Business plus + GRE / GMAT + Conversation $432 $352 $320 $307 $296 Program Starting Dates January: February: March: April: May: June: July: August: September: October: November: December: F1 Students 07 04 04 01 28 24 22 19 16 15 12 09 29 NON F1 Students Program Starting Dates January: February: March: April: May: June: July: August: September: October: November: December: 07 04 04 01 06 03 01 05 03 07 04 02 14 11 11 08 13 10 08 12 09 15 12 09 22 19 18 15 20 17 15 19 16 21 18 16 28 25 25 22 28 24 22 26 23 28 25 23 29 29 30 INITIAL FEE (ONE-TIME ONLY) $150: Processing Fee (Non refundable) $100: FedEx Shipping Fee (I-20) $200: SEVIS Fee* *Only for students who want us to make the SEVIS payment. National holidays Jan. 1st, 21st, Feb. 18th, May 27th, July 4th, Sept. 2nd, Oct. 14th, Nov. 11th, 28th, 29th Christmas Winter Break Dec. 24th, 25th, 26th, 27th, 28th, 29th, 30th, 31st, Jan.1st

SCHOOL CALENDAR 2019 WINTER 2019 January 2019 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 February 2019 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 March 2019 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 HOLIDAYS: 01/01 - New Year s Day 01/21 - Martin Luther King Jr. Day 02/18 - President s Day SPRING 2019 April 2019 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 May 2019 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 June 2019 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 HOLIDAYS: 05/27 - Memorial Day 1 SUMMER 2019 July 2019 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 August 2019 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 September 2019 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 HOLIDAYS: 07/04 - Independence Day 09/02 - Labor Day FALL 2019 HOLIDAYS: 10/14 - Columbus Day 11/11 - Veterans Day 11/28 - Thanksgiving 11/29 - Day after Thanksgiving CHRISTMAS WINTER BREAK 12/24/19-01/01/20 October 2019 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 November 2019 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 December 2019 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Program start dates No school due to national Holydays January 2020 Last day of the Term (no classes + End-of-term Party) 1 2 3 4 5 6 7 8 9 10 11 School Break HOLIDAYS: 01/01 - New Year s Day

PLACEMENT FEE A cancellation $300/$270 fee will be charged if a student cancels the housing request less than 14 days before the occupancy date. SECURITY DEPOSIT If there is no damage in a student s room and property. The student will receive a full security deposit refund. The cost of any damage will be deducted from the security deposit. The student must submit the Refund Request Form in order to receive a refund. AIRPORT PICKUP Guaranteed airport pickup from 8AM to 8PM (depending on flight arrival time). Accommodation check-in time from 9AM to 9PM. Guaranteed pickup time (from accommodation) between 7AM to 7PM. All students need to check-out from the accommodation before 12PM. We cannot guarantee airport pickup at any other time. Please contact USSS before booking your flight for other possible pickup times. There is a $35 early/late pickup fee (if possible). All students who request our housing service MUST use our airport pick up service If our airport pick up service is NOT requested, $30 will be added to the placement fee. OUR AIRPORT PICKUP SERVICE INCLUDES: Meeting students at Los Angeles International Airport. Taking students to their accommodation and showing them how to commute to and from the school. Explain the housing rules and agreement before they move into their accommodation. Please note that we will NOT be able to provide these services if a student arrives after 6:00pm OUR AIRPORT DROP OFF SERVICE INCLUDES: Picking students up from their accommodation. Helping students check in. RENT *The housing agreement is a periodic rental agreement. There is no refund or cancellation of the rental agreement after moving into housing. **If you request a Homestay shared room, you MUST apply with another person.

ADMISSION POLICY BOOKING PROCESS: 1. F-1 STUDENTS 1. Fill out on-line application form: https://mliesl.edu/ admission/ or the pre-enrollment application form. 2. E-mail (Westwood campus: info@mliesl.edu or Hollywood campus: hollywood@mliesl.edu ) or fax (Westwood campus: 1-310-593-2499 or Hollywood campus: 1-323-488-9748) the application form with the following documents: A copy of your passport (photo page) A copy of your or your family s bank statement. The minimum balance needs to be over $15,600 and issued within 3 months of application submission. A housing application form, if you need housing such as a home stay or dormitory from U.S. Student Services Inc. A copy of your transcript or latest diploma from high school or higher education. 3. Our admissions office will e-mail you. 4. Please make the initial payment or full payment using the credit card form attached. 5. As soon as the initial or full payment is confirmed, we will issue an I-20, an acceptance letter and a I-901 (SEVIS fee receipt if requested) and FedEx them to you. We will also inform you of the FedEx tracking number. 6. Please apply for a student VISA at the U.S. Embassy in your country. 7. Once you book your flight, please send the following information: Arrival date Arrival time Airline company Flight number 8. We will send final confirmation which has information about MLI s new student orientation. 2. NON F-1 STUDENTS 1. Fill out on-line application form: https://mliesl.edu/ admission/ or the pre-enrollment application form. 2. E-mail (Westwood campus: info@mliesl.edu or Hollywood campus: hollywood@mliesl.edu ) or fax (Westwood campus: 1-310-593-2499 or Hollywood campus: 1-323-488-9748) the application form with the following documents: A housing application form, if you need housing such as a home stay or dormitory form U.S. Student Services Inc. 3. Our admissions office will e-mail you. 4. Please make the initial payment or full payment using the credit card form attached. 5. As soon as the initial or full payment is confirmed, we will send you an acceptance letter. 6. Once you book your flight, please send the following information: Arrival date Arrival time Airline company Flight number 7. We will send final confirmation which has information about MLI s new student orientation. 3. TRANSFER STUDENTS 1. Fill out on-line application form: https://mliesl.edu/ admission/ or the pre-enrollment application form. 2. E-mail (Westwood campus: info@mliesl.edu or Hollywood campus: hollywood@mliesl.edu ) or fax (Westwood campus: 1-310-593-2499 or Hollywood campus: 1-323-488-9748) the application form with the following documents: A copy of passport (photo page) A copy of your student visa A copy of your I-94 A copy of your current I-20 Signed transfer form A copy of your or your family s bank statement. The minimum balance needs to be over $4,000 and issued within 3 months of application submission. A housing application form, if you need housing such as with a home stay or dormitory form U.S. Student Services, Inc. A copy of your transcript or latest diploma from high school or higher education. 3. Our admissions office will e-mail you. 4. Please make the initial payment or full payment using the credit card form attached. 5. As soon as the initial or full payment is confirmed, we will issue a new I-20 and an acceptance letter. We will also send final confirmation which has information about MLI s new student orientation.

English+ Program Price Charts - 2019 MLI - Westwood & Hollywood campus: English+ Program with housing Popular Programs: Both Westwood & Hollywood campus Only Hollywood campus Only Westwood campus English+ Housing 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks 7 weeks 8 weeks 9 weeks 10 weeks 11 weeks 12 weeks Dance (Edge Performing Arts) Dance (Millennium Dance Complex) Dance (Debbie Reynolds) Homestay $1,602 $2,314 $3,036 $3,588 $4,025 $4,652 $5,289 $5,896 $6,533 $7,160 $7,797 $8,404 Dormitory $1,448 $2,036 $2,634 $3,090 $3,385 $3,870 $4,365 $4,830 $5,325 $5,810 $6,305 $6,770 Homestay $1,607 $2,324 $3,051 $3,627 $4,069 $4,701 $5,343 $5,974 $6,616 $7,248 $7,890 $8,521 Dormitory $1,453 $2,046 $2,649 $3,129 $3,429 $3,919 $4,419 $4,908 $5,408 $5,898 $6,398 $6,887 Homestay $1,592 $2,294 $2,986 $3,617 $4,044 $4,661 $5,268 $5,954 $6,581 $7,198 $7,805 $8,491 Dormitory $1,438 $2,016 $2,584 $3,119 $3,404 $3,879 $4,344 $4,888 $5,373 $5,848 $6,313 $6,857 Dance Homestay $1,597 $2,304 $3,021 $3,568 $4,000 $4,622 $5,254 $5,856 $6,488 $7,110 $7,742 $8,344 (MOVEMENT LIFESTYLE) Dormitory $1,443 $2,026 $2,619 $3,070 $3,360 $3,840 $4,330 $4,790 $5,280 $5,760 $6,250 $6,710 Yoga Yoga Teacher Training Program Music (Including Voice Training) Surfing Scuba Diving Homestay $1,667 $2,314 $2,961 $3,468 $3,970 $4,532 $5,094 $5,656 $6,358 $6,920 $7,482 $8,044 Dormitory $1,513 $2,036 $2,559 $2,970 $3,330 $3,750 $4,170 $4,590 $5,150 $5,570 $5,990 $6,410 Homestay x x x $7,028 x x x x x x x $11,324 Dormitory x x x $6,530 x x x x x x x $9,690 Homestay $1,741 $2,522 $3,323 $3,984 $4,500 $5,216 $5,932 $6,648 $7,364 $8,080 $8,796 $9,512 Dormitory $1,587 $2,244 $2,921 $3,486 $3,860 $4,434 $5,008 $5,582 $6,156 $6,730 $7,304 $7,878 Homestay $1,767 $2,614 $3,451 $4,128 $4,690 $5,452 $6,214 $6,976 $7,738 $8,500 $9,262 $10,024 Dormitory $1,613 $2,336 $3,049 $3,630 $4,050 $4,670 $5,290 $5,910 $6,530 $7,150 $7,770 $8,390 Homestay x x x $4,027 Ask Ask Ask Ask Ask Ask Ask Ask Dormitory x x x $3,529 Ask Ask Ask Ask Ask Ask Ask Ask *The dormitory packages are based on a quad room. Room upgrade price 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks 7 weeks 8 weeks 9 weeks 10 weeks 11 weeks 12 weeks Quad (4) -> Shared (2) room +$91 +$182 +$273 +$252 +$315 +$378 +$441 +$504 +$567 +$630 +$693 +$756 Quad (4) -> Private (1) room +$219 +$438 +$657 +$680 +$850 +$1020 +$1,190 +$1,360 +$1,530 +$1,700 +$1,870 +$2,040 English+ College at UCLA Extension** Winter term (12 weeks) Spring term (12 weeks) Summer term (12 weeks) Fall term (12 weeks) Jan 8-Apr 1 Apr 2-Jun 24 Jun 25-Sept 16 Sept 17 Dec 9 Homestay $7,624 $7,624 $7,624 $7,624 Dormitory $5,990 $5,990 $5,990 $5,990 **Classes at UCLA Extension Student will pay the fee for UCLA Extension when he or she starts UCLA Extension classes. The tuition fee for UCLA Extension will cost approximately $800/4 units (1 class) or $1,600/8 units (2 classes). All prices are subject to change. If you have any requests, such as upgrading the room type or number of lessons, please ask the Admissions Office.

2019

PRE-ENROLLMENT APPLICATION If you have any questions regarding this form, please email or call the center you are applying to. Please check your preferred campus: Westwood Hollywood Family Name (Surname): Are you a transfer student? Yes No Please select the date in 2019 you wish to start: Jan 7th Feb 4th Mar 4th Apr 1st Apr 29th May 28th June 24th July 22nd Aug 19th Sep 16th Oct 15th Nov 12nd Dec 9th First (Given) Name: Country of Birth: Middle Name: Date of Birth (month/day/year): Student Information: Country of Citizenship: Sex: Male Female City/Province of Birth: Email Address: Home Country Street Address: City: State: Postal Code: Country: Phone: Mobile Phone: How did you hear about MLI? Please indicate name and source (i.e. Internet, Google, Agent, etc.): ESL q ESL Program (20 hours per week) q q Program (18 hours per week) q q Conversation Program (18 hours per week) q Program Combination Options Option 1 (ESL + = 25 hours per week) q q q Test Preparation Programs Preparation Program (18 hours per week) Business Plus Program (18 hours per week) GRE / GMAT (18 hours per week) Option 2 ( + TIP = 23 hours per week) Option 3 (2 Programs) Class Schedule: Morning Afternoon Course Length: 12 Weeks 4 Weeks Other Do you need an I-20? Yes No In addition to the fees below, all I-20 applications must be accompanied by a financial statement verifying your ability to meet expenses. (Estimated expenses per school year: $15,600.00 USD) If Yes, please indicate how you would like us to deliver your I-20: Express Mail (check fee below) Pick up (by friend or relative in the U.S.) Required Fees: Processing Fee* ($150) Optional Fees: SEVIS Fee** ($200) Express Mail* ($100) *non-refundable Total Fees: **non-refundable; you may either pay this fee directly to SEVIS or Mentor Language Institute, who will pay it for you. I have read and understood that this is a pre-enrollment application, that I must request a refund if I cancel (and that certain fees are non-refundable, as noted), and that my enrollment will not be completed until I obtain a visa (if required) and execute an enrollment agreement in person at an MLI campus. Signature: Date (month, day, year): / / 20

1 U.S. SUPPORT SERVICES INC. Move In Date: Move In Date: / / mm/ dd /yyyy 2018 2019 HOUSING APPLICATION Move Out Date: Move Out Date: / / mm/ dd / yyyy Agent Name: Agent Name: U.S. U.S Support Services Inc. Inc. 6755 10880 Hollywood Wilshire Blvd., Suite Suite 122, 300 Los Los U.S. Angeles, Support CA 90024 Services 90028 USA USA Inc. Phone: 10880 424-253-3169 Wilshire Blvd., Suite 122 Phone: 424-253-3169 Fax: Los 424 Angeles, 203-6123 CA 90024 USA FAX: 424-203-6123 Email: Phone: info@usssinc.net 424-253-3169 E-mail: Fax: 424 info@usssinc.net 203-6123 Email: For office use info@usssinc.net only: For office use only: Application Received: / / Program Start Date: / / 2 Housing Options: (select campus and indicate the housing option) Westwood Deposit $200 Homestay (Private, 2 meals/day) $377/week, $1,368/4 weeks Hollywood Deposit $200 Homestay (Private, 2 meals/day) $377/week, $1,368/4 weeks Dormitory (Private, No meals) $447/week, $1,480/4 weeks Dormitory (Private, No meals) $447/week, $1,480/4 weeks Dormitory ( Shared-2, No meals) $319/week, $1,052/4 weeks Dormitory ( Shared-4, No meals) $228/week, $800/4 weeks Dormitory ( Shared-2, No meals) $319/week, $1,052/4 weeks Dormitory ( Shared-4, No meals) $228/week, $800/4 weeks Package Options: Dance (Studio: ) (Number of Tickets: ) Yoga: week(s) Music: week(s) Surfing: week(s) Scuba Diving: week(s) *Dormitory Maintenance Fee $25/week, $100/4 weeks or more *Dormitory Maintenance Fee $25/week, $100/4 weeks or more Airport Pick-up $130 -All applicants must use our airport pickup service. Guaranteed pickup is 8AM to 8PM (flight arrival time) and/or accommodation check-in time is 9AM to 9PM.) A Airport Drop-off $130 - Guaranteed pickup time (accommodation) is 7AM to 7PM. The accommodation check-out time is 12PM. *Any other times are not guaranteed, U.S.S.S. may pickup from 8PM to 10PM with a $35 late pickup fee.) TAP Card $2 (Metro Bus Pass $25/7 days, $100/30 days) *If your accommodation is not in a Metro area, the fee will be refunded. 8888 3 4 5 6 7 8 9 Student Information: Last Name (Family name): First (Given) Name: Nationality: Gender: Male Female Visa: F-1 Other Date of Birth: (MM/ Personal Information: Smoker: Yes No Note: No homestay families allow smoking; you must smoke outside. Allergies: Do you have any allergies? Yes No If yes, please list: Arrival Information: Arrival Date: (MM/DD/YYYY) Arrival Time: Airline: Flight#: Emergency Contact Information: Name: Relationship: Telephone: E-mail: Preferences for students choosing a Homestay Family (We will do our best to meet your preferences; however, we cannot guarantee that we will meet all of them. For best results please submit this application at least 30 days before you plan to move in.): I prefer a family with children: Yes No Most important for me (Please choose one): Time to talk with the family. Location. I want to be as close to the school. Other: Other: If you have any handicaps (either mental or physical), you may list them here so that we can accommodate your needs. Please note: by listing any information here, you agree that we may share this information with third parties as we see fit. If you have any other requests or would like to provide any other information, please do so here: By signing below, I hereby certify that the facts set forth above are complete and true to the best of my knowledge. I agree that my application will not be processed until U.S.S.S. has received $270/$300 from me for placement in a homestay or in a dormitory. [If a student rejects our airport pickup service, an additional $30 will be charged.] I agree that a cancellation fee of $270/$300 will be charged if I cancel the housing request less than 14 days before the occupancy date as listed above. I agree that a cancellation fee of $130 will be charged if I cancel the airport pickup service or change my flight less than 72 hours before the scheduled arrival time. If I postpone my arrival date from the date listed above, I understand that I will be charged a new placement fee or a rental fee. I also understand that I need to pay a maintenance fee and a security deposit on my arrival. The maintenance fee is non-refundable. The security deposit is refundable after moving out, as long as there is no damage to the room and property. A Refund Request Form must be filled out. This application is for the periodic rental agreement, and the period of my stay is specified above. I agree to move out on the date above. I have the option to extend my stay only if there is availability. I understand that if I am enrolled with Mentor Language Institute and cancel my enrollment, my U.S.S.S. accommodation will be terminated. Termination will occur within the grace period. I understand that falsification of any information on this form will result in forfeiture of the placement fee without refund. I have read and agree to these terms. Print name: Signature: Date: USSS080816

Mentor Language Institute Credit Card Payment Form Westwood Campus Hollywood Campus Student Name: Last First Card Type: Card Number: Expiration Date (MM/YY): Visa MasterCard Security Code: Name on Card: Last First Billing Address: (City) (State / Province) (Zip Code / Postal Code) (Country) Amount authorized to charge: US $ I hereby authorize Mentor Language Institute to charge the above amount to my credit card. Card Holder s Signature: Date: Westwood Campus WESTWOOD 10880 Wilshire Boulevard, Suite 122 10880 Wilshire Blvd., Suite 122, Los Angeles, CA 90024 Phone: 310-887-0777 Los Angeles, / Fax: CA 310-593-2499 90024 Phone: Email: 310-887-0777 info@mliesl.edu / FAX: 310-593-2499 E-mail: info@mliesl.edu Hollywood Campus HOLLYWOOD 6755 Hollywood Boulevard, Suite 300 7080 Hollywood Blvd., Suite 314 Hollywood, CA 90028 Phone: 323-870-7102 Hollywood, CA 90028 / Fax: 323-488-9748 Phone: 323-870-7102 Email: hollywood@mliesl.edu / FAX: 323-488-9748 E-mail: hollywood@mliesl.edu

U.S. Support Services Inc. U.S Support Services Inc. 6755 10880 Hollywood Wilshire Blvd., Blvd, Suite Suite 122, 300 Hollywood, Los Angeles, CA CA 90028 90024 Tel: Phone: 424-253-3169 / Fax: FAX: 424-203-6123 Westwood Hollywood Student Name: Last First Card Type: VISA Mastercard Card Number: Expiration Date (MM/YY): / Security Code: Name on the card: Last First Billing Address: City State / Province Zip / Postal code Country Amount authorized to charge: US $ I herebery authorize U.S. Student Services Inc. to charge the above amount to my credit card. Card Holder's Signature: Date: