English Language Institute (ELI)/Undergraduate Admissions Bridge Program Application

Transcription

1 Send your completed application to: English Language Institute University of Maryland, Baltimore County (UMBC) 1000 Hilltop Circle, UC Room 207 Baltimore, MD USA Phone Fax: eli@umbc.edu Session Start Dates: Summer 2014 May 22, 2014 Fall 2014 Session 1 August 25, 2014 Fall 2014 Session 2 October 20, 2014 Spring 2015 Session 1 January 22, 2015 Spring 2015 Session 2 March 19, 2015 Summer 2015 May 21, 2015 Fall 2015 Session 1 August 24, 2015 Fall 2015 Session 2 October 19, 2015 Application Term 1. In which session do you wish to start the ELI program? Summer 2014 Fall 2014 Session 1 Fall 2014 Session 2 Spring 2015 Session 1 Spring 2015 Session 2 Summer 2015 Fall 2015 Session 1 Fall 2015 Session 2 Admit Type 2. Freshman: Never studied at college/university Transfer: Studied at college/university Personal Information 3. Other name(s) that may appear on your records 4. Date of Birth (Month/Day/Year) 5. Gender: Male Female 6. of Citizenship of Birth 7. Student s Phone Number (include country code) 8. Student s Address 9. Native Language 10. Are you of Hispanic or Latino origin? Yes No What is your race? Select one or more of the following categories: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Address Permanent address in your country of citizenship: 11. Street City State/Province Mailing address for delivery of I-20 (if different from above): Person/Company Name Street City State/Province 12. Phone number required for express mail delivery (include country code)

2 Academic Information 13. Please indicate your intended area(s) of undergraduate study Select a Major Select a Second Major (Optional) Acting ACTG BFA Africana Studies AFST BA American Studies AMST BA Ancient Studies ANCS BA Asian Studies ASIA BA Biochemistry & Molecular Biology BIOC BS Bioinformatics & Computational Biology BINF BS Biological Sciences BIOL BS Biological Sciences BIOL BA Business Technology Administration BTA BA Chemistry CHEM BA Chemistry CHEM BS Chemistry Education CHED BA Chemical Engineering CENG BS Computer Engineering CMPE BS Computer Science CMSC BS Cultural Anthropology ANTH BA Dance DANC BA Economics ECON BA Emergency Health Services EHS BS Engineering ENGR BS English ENGL BA Environmental Science ENSC BS Environmental Studies ENVS BA Financial Economics FIEC BS French FREN SPC Gender & Women s Studies GWST BA Geography & Environmental Systems GEOG BA Geography & Environmental Systems GEOG BS Global Studies GLBL BA Health Administration & Policy HAPP BA History HIST BA Information Systems IFSM BS Interdisciplinary Studies INDS BA Interdisciplinary Studies INDS BS Management of Aging Services MAGS BA Mathematics MATH BA Mathematics MATH BS Mechanical Engineering MENG BS Media & Communication Studies MCS BA Modern Languages & Linguistics MLL BA Music MUSC BA Music - Composition MUCO SPC Music - Education MUED SPC Music - Instrument Performance INPE SPC Music - Jazz JAZZ SPC Music - Performance/ Musicology PEMU SPC Music - Recording MURE SPC Music - Undecided UNDC SPC Music - Vocal Performance VOPE SPC Philosophy PHIL BA Physics PHYS BS Physics Education PHSE BA Political Science POLI BA Pre-Dental Hygiene DENT OPT Pre-Nursing NURS OPT Pre-Pharmacy PHAR OPT Psychology PSYC BA Psychology PSYC BS Russian RUSS SPC Social Work SOWK BA Sociology SOCY BA Spanish SPAN SPC Statistics STAT BS Theatre THTR BA Theatre - Acting ACTG SPC Theatre - Design/Production DPRO SPC Undecided UGST BA Visual Arts - Animation/ Interactive Media AI SPC Visual Arts - Art History AR SPC Visual Arts - Film/Video FV SPC Visual Arts - Graphic Design GR SPC Visual Arts - Photography PH SPC Visual Arts - Print Media PR SPC Visual Arts - Undecided UN SPC Visual Arts - Animation/ Interactive Media AIBFA SPC Visual Arts - Film/Video FVBFA SPC Visual Arts - Photography PHBFA SPC Visual Arts - Print Media PRBFA SPC 14. List the high (secondary) school from which you graduated or expect to graduate. HIGH (SECONDARY) SCHOOL NAME LOCATION (CITY, STATE/PROVINCE, COUNTRY) DATES ATTENDED GRADUATION DATE DEGREE EARNED (YES/NO) FROM T0 15. Have you attended a university (education after secondary school)? UNIVERSITY NAME LOCATION (CITY, STATE/PROVINCE, COUNTRY) DATES ATTENDED CREDITS ATTEMPTED CREDITS EARNED DEGREE EARNED FROM T0 16. Have you ever been convicted or found guilty of any criminal or military offense, excluding minor traffic violations? Yes* No 17. Have you ever been academically dismissed from, declared ineligible to attend, or incurred disciplinary action at any previous institution? Yes* No If you answered yes to either or both questions, please attach a separate sheet of paper that gives the approximate date of each incident, explains the circumstances, and reflects on what you learned from the experience.

3 Contacts 18. U.S. Contact Person (family or friend in the U.S., if available) Address of U.S. Contact: 19. Street City State/Province 20. Phone Number 21. Address 22. List names and relationships of any family members who have graduated from UMBC: Agent 23. Agent Information (if applicable) Company Agent Name Agent Address: 24. Street City State/Province 25. Phone Number (include country code) 26. Address How Did You Find Us? Family member, friend, or former ELI student ELI website Agent ELI/UMBC representative Other: Name: Visa Status 27. Are you in the U.S. now, OR did you study in the U.S. within the last five months? Yes If yes, what is your current visa status? F-1 Send an I-20 transfer form, a copy of your passport, visa, I-20 and I-94. (I-20 Transfer Form: Other: Financial Documents If you plan to obtain a student (F-1) visa you must submit: 1. A letter financial support, which you may access from from your parents or financial sponsor to the effect that he or she is willing and able to provide U.S. $35,000 for each year of study; and 2. A bank statement that verifies that the individual(s) providing your support has the U.S. $35,000 on deposit. No Financial documents should: be recent (less than 3 months old) and in English be an official/original document (not a copy) created by a bank or by a government/company sponsor

4 Application Fee 28. Please enclose a $100 nonrefundable application fee. Method of Payment: Credit Card Card type: Visa MasterCard Discover Money Order Personal Check (payable to UMBC) from a bank with a U.S. branch. The account holder s address must be on the check. Credit Card Details: Credit Card Number Credit Card Expiration Date Card Security Code (3-digit number on back of card) Cardholder s Name Cardholder s Phone Number Cardholder s Address Cardholder s Complete Billing Address Cardholder s Signature

5 Dependents If you will apply for F-1 status and wish to bring a dependent (spouse or child) to the U.S., complete the following information for each dependent. Attach an additional page if needed. You must also attach documents that prove your relationship to the dependent (proof of marriage, birth, etc.) and provide a copy of the dependent's passport. Your financial documents should include an extra $9,000 for a spouse, $6,000 for each child Date of Birth (Month/Day/Year) 31. of Citizenship 32. Relationship to Applicant: Wife Husband Son Daughter Signature Please send these items with your application: Application fee of $100 Financial documents (required for F-1 visa applicants) Copy of your passport (photograph page) Official high (secondary) school transcript (record of classes and grades) Official university transcript (if applicable) 33. I certify that the information I have provided on and with this application is correct and complete. If it is not, I understand that cancellation of admission and registration may result. I agree to abide by the rules, policies, and regulations of UMBC, including those concerning drug and alcohol abuse, and I understand that unlawful use of drugs or alcohol will subject me to the penalties contained in those policies and regulations. Signature of applicant Signature of parent if applicant is under 18 Date