Directions: Please complete this form as carefully and accurately as possible since it may be used to create your Form I-20 and F-1 Student Visa in addition to your standard intensive English program record. ELI Application Purpose I understand that this ELI Application is for the purpose of studying in Sam Houston State's English Langue Program only and will not be considered for conditional admission to any degree-awarding program at the university. I understand that this application is for the intensive English program only and cannot be considered for conditional admission and will apply to SHSU for academics at a later date. Which semester are you applying for?* Summer 2020 (June 8 - August 7) Personal Information First Name (Given Name) * Last Name (Family Name) * Primary Email Address * Date of Birth (Month / Day / Year) * Gender * Male Female Country of Birth * Country of Citizenship * Attach a copy of your most recent passport * Native Language * What is your intended visa while in ELI? * Do you have any dependents (spouse, children, etc.) that will need to have immigration documents created based on your application? * Yes No If "Yes", attach a copy of your dependent's passport or visa What is this person's relationship to you? (Parent, sibling, spouse, child, etc.): Additional Dependent Passport What is this person's relationship to you? (Parent, sibling, spouse, child, etc.): Are you bringing more than two dependents? Email email@example.com to let us know. Permanent Address Street Address (in your home country) * City * State or Province * Country * Postal Code / Zip Code * Foreign Telephone # (in your home country) * Mailing/Shipping Address ELI will use this address to mail or ship you any documents such as an I-20, acceptance package, or other materials. Mailing/Shipping Street Address * City * State or Province * Country * Postal Code / Zip Code * Mailing/Shipping Telephone Number (in your home country) * Previous Education / Test Scores Name of the high school you graduated from (either in the US or in your home country) * Date of your high school graduation. (Month / Day / Year) * Please attached a copy of your final High School Transcript. Have you earned a Bachelor's degree before? * Yes No If "Yes", which school did you receive your degree from? Have you ever attended any colleges, universities, or English programs in the US? * Yes No Which schools in the US have you attended? Have you ever taken the TOEFL or IELTS exam before? * Yes No If "Yes", attach a copy of your complete score report(s) International Transfer Students Are you currently studying in the US? (will you be considered a transfer student if accepted?) * Yes No If "Yes", at which school are you currently studying If "Yes", attach a copy of your current visa If "Yes", attach a copy of your most recent grades (transcript) from your current program/university Financial Documents Financial Declaration: Students must demonstrate evidence of financial support for one academic year (9 months) in order to be issued a Form I-20. The approximate cost of a 9-month period of study at the SHSU English Language Institute is US $18,500 for tuition, fees, books, housing, meals, and personal expenses. An additional $2000 is required for each dependent included on the Form I-20. Attach an original official bank letter in English, stating that sufficient funds are available to support your stay in the United States. How much money, in USD, will be available for your study here at SHSU ELI? * Please attach a letter/statement from your bank (in English) covering the amount stated above Do you plan to be sponsored by a 3rd party organization (such as SACM) while studying at SHSU ELI? * Yes No If you answered "Yes," what is the name of your sponsoring institution? If you answered "Yes," what is your ID number that your sponsor assigned to you? If you answered "Yes," please attach any scholarship letters to cover the amount stated above. Emergency Contact Information Please put the name of your preferred emergency contact (the person SHSU ELI can contact if you are involved in an accident or have a medical emergency): * What is this person's relationship to you? (Mother, Father, Husband, Brother, Friend, etc.): * Please list this person's phone number: * Please list this person's email address: * Academic Plans Which degree program are you interested in studying? * Please indicate if you used an agency to help you with this application * Yes No If yes, please provide the agency’s name If no, how did you hear about SHSU ELI? * Search Engine School Advisor Family or Friend Email/Newsletter Facebook/Twitter Magazine/Newspaper Radio/Television YouTube/Youku Other Please give other source Application Fee ($75) In addition to this application, all students are required to submit a non-refundable $75 USD application fee. We will not be able to process your application without this fee. To pay this fee online go to https://secure.touchnet.com/C21329_ustores/web/store_main.jsp?STOREID=32. This fee is non-refundable and non-transferable. Please print receipt and attach. By clicking the "Submit Application" button below, I confirm that the application information provided is correct and accurate and that I understand that I may be asked to provide additional documents or fees if necessary to complete my application.