ELLI Application

Please answer these questions to help us to assign you to the most appropriate English course:

Personal Information

Family Name (Surname)
First Name (Given name)
Date of Birth (MM/DD/YYYY)
Sex	Male Female
Country of birth
Country of citizenship
Place of residence (city, state, country, Zip)

Education and Career Information

What is your highest educational degree or diploma?	High school Diploma Bachelors Masters Doctorate Other
What is your present occupation?	High school student Undergraduate student Graduate student Other
Major
If you work, please enter your job title
What is your educational objective in the USA?	Undergraduate study Graduate study English study only
If you plan to study for a degree, what major do you plan to study?

Your English language needs

How many years have you studied English? Enter number of years or months
Where did you study English?
What is your level in English?	Low beginner High beginner Intermediate Advanced
What are you strongest at in English?	Listening Speaking Reading Writing Vocabulary Grammar Pronunciation [saying words correctly]
What are you weakest at in English?	Listening Speaking Reading Writing Vocabulary Grammar Pronunciation [saying words correctly]

Courses Offered

Check the course you want to take:	Spring 2012, 7 weeks, classes start March 19 Summer 2012, 7 weeks, classes start June 25 Fall 2012, 14 weeks, classes start September 3 Fall 2012, 7 weeks, classes start October 29 Note: new international students should arrive one week before the start of classes

Check the course you want to take:

Spring 2012, 7 weeks, classes start March 19

Summer 2012, 7 weeks, classes start June 25

Fall 2012, 14 weeks, classes start September 3

Fall 2012, 7 weeks, classes start October 29

Note: new international students should arrive one week before the start of classes

Conditional Admission

Do you want to apply for conditional admission to Angelo State at the same time as to ELLI?	Yes No Not Sure
If yes, which degree program do you propose to study at Angelo State:

Visa Information

Are you presently in the United States?	Yes No
Are you a United States citizen?	Yes No
Are you a United States permanent resident?	Yes No
Do you presently have a United States visa?	Yes No
If yes, which type?
Do you want to apply for an I-20AB?	Yes No Not Sure
Are you a transfer student currently in the U.S. with an I-20?	Yes No
If yes, which school issued your I-20?
If requesting an I-20, do you want it sent by express mail?	Yes No

Our Program

How did you hear about the ESL program at the ELLI?	ASU website Language Travel Magazine San Angelo Standard-Times ELLI brochure Conexion Hispana Word of mouth Radio/TV broadcast Other. Please specify

Your contact details

E-mail address
Telephone
Fax
Postal code
Mailing address

Do you have any questions or comments?

Application Process

As well as completing this form, please send:

$50 application fee [see Payment information in How to Apply]
If requesting an I-20 by express mail, $50 Express mail fee [see How to request an I-20 in How to Apply]
If requesting an I-20, a completed Official Sponsor Financial Statement and an original bank statement or a letter from a financial institution which confirms you have enough funds to cover the duration of your course [see table below]
A photocopy of your passport identification page [by fax, email attached document or mail]

Total estimated expenses for F1 visa: includes tuition, fees, insurance, housing, estimated food and personal expenses^*
Program Length	Cost
7 week fall, spring, and summer semesters (8 weeks in USA)	$4,639
14 week fall and spring semesters (16/17 weeks in USA)	$9,278
Each additional week in the U.S. (e.g. 4 or 5 week inter semester breaks in summer and winter)	Approx. $275.00

^* Includes tuition, fees, insurance, housing, and estimated food and personal expenses.

Any queries?
Contact:
Carole Simpson
English Language Learners’ Institute Coordinator
Centre for International Studies
Angelo State University
ASU Station #11035
San Angelo, TX 76909-1035
E-mail: ELLI@angelo.edu
Phone: (325) 942-2083
Fax: (325) 942-2084

Who Are You?

ELLI Application

Angelo State University

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