L.E.A.P. INTENSIVE ENGLISH PROGRAM ONLINE APPLICATION FORM

 

 

ENTER YOUR INFORMATION BELOW AND SUBMIT THE FORM:

1. Starting Term: Fall - August (15 weeks) Spring - January (15 weeks) Summer - June (10 weeks)

2. Name: Family Name : First Name : Middle Name :

3. Social Security Number (If you have it):

4. Address: City : State/Province : Postal Code : Country :

5. Contact Information: Telephone : Fax : Email: (Required)

6. Personal Data: a. Date of Birth: Month : Day : Year : b. Country of Birth: c. Citizenship: d. Native Language: e. Male Female f. Married Single

7. Will your spouse accompany you? Yes No a. Name of spouse: b. Date of Birth: Month : Day : Year : c. Country of birth:

8. Will your children accompany you? Yes No a. Name(s) of children: 1a. Name : 1b. Date of Birth: Month : Day : Year : 1c. Country of Birth : 2a. Name : 2b. Date of Birth: Month : Day : Year : 2c. Country of Birth : 3a. Name : 3b. Date of Birth: Month : Day : Year : 3c. Country of Birth :

9. Person in the United States (if any) we may contact concerning your arrival: a. Name: b. Address: c. Telephone:

10. Are you NOW in the United States? Yes No a. If your answer is yes, when did you come to the United States? Month: Year: b. What type of visa do you hold? (Note: If you are transferring to the L.E.A.P. Program from a school in the United States, please send us a photocopy of the I-20 you currently hold)

11. If you are not in the United States at this moment, do you wish to be sent an I-20 for a student Visa? Yes No a. If no, on which Visa do you intend to enter the United States?

12. Are you being sponsored by an agency or embassy to study in the United States? Yes No a. If yes, what is the name of the organization?

13. Educational Objective in the United States: Language Training Only Undergraduate Study Graduate Study

14. If you planning to study as a undergraduate or graduate at an American college or university, what will be your major area of study?

15. Have you been admitted to an American college or university? Yes No a. If yes, what is the name and location of the institution? b. When do you think you will begin your studies? Month: Year :

16. Are you applying or do you plan to apply for regular admission to Marshall University after completing the L.E.A.P. Program? Yes No What is the name of the program that you want to study?

17. Educational Background: I have not finished high school I have finished high school (Completation date): I have finished year(s) of college year(s) of university

18. Have you studied English? Yes No

19. Present knowledge of English: Speaking: poor fair good excellent Listening: poor fair good excellent Writing: poor fair good excellent Reading: poor fair good excellent

20. Have you taken the TOEFL? Yes No a. If yes, what was your score?

21. Where would you like to live: In a university dormitory in married student housing Off campus

22. How did you learn about the L.E.A.P. Intensive English Program? Friend or Relative Name : Embassy or Consulate Name : Advertisement Name : Internet Where on the internet? : Other Name: :

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THANK YOU FOR YOUR APPLICATION!

WE WILL RESPOND TO YOU WITH AN EMAIL VERY SOON!

Dr. Clark Egnor, Director - Marshall University, L.E.A.P. Intensive English Program One John Marshall Drive, Old Main 320, Huntington, West Virginia, U.S.A. 25755 Tel: 304-696-6265 Fax: 304-696-6353 Email Us