English Language Institute, Oregon State University

Please check the first term you plan to enroll:
Summer (8 weeks)   Fall   Winter   Spring Year:

How many terms do you plan to attend the ELI?
1 term   2 terms   3 or more terms  

Family Name:
Given Name: Other Name:

Date of Birth (Month/Day/Year, as in 02/14/85):

Country of Birth:

Country of Citizenship:

Male Female

Single Married

If married, will your husband or wife accompany you? Yes No
Spouse's Name
Spouse's date of birth (Month/Day/Year, as in 02/14/85):

Please give the full names and birthdates of any children who will accompany you to Corvallis:
Child's Name Date of Birth

Child's Name Date of Birth

Child's Name Date of Birth

Do you have a physical disability? Yes No If so, please describe it and the special services you may need:

Addresses

Mailing Address (Admission notice and I-20 will be sent here)
Line 1
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Telephone:
Fax:
Electronic mail:

Permanent Home Country Address (if different from mailing address)
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Line 2
Line 3
Line 4
Permanent email address

Please check the type of visa you will use while studying at the English Language Institute.

Student (F) Exchange visitor (J)
Other: what type?

Are you transferring to the ELI from another school in the United States? Yes No

(If you are transferring, a "Transfer Eligibility" form will be sent to you. Please fill it out and return it to the ELI.)

Have you graduated from high school? Yes No
Date if yes: If not, when will you graduate?

Have you attended a college or university? Yes No
If yes, highest degree:

Have you taken the TOEFL test? Yes No
If yes, what was your score?
Date (month/day/year, as in 1/25/04):

What do you plan to do after you complete your English language study?

How did you hear about the English Language Institute at OSU?

Applicants must provide evidence of adequate funds to pay for educational and living expenses for a minimum of three terms. Please indicate below the source or sources of financial support.

Source of support	Required Documents	Guaranteed support in US dollars
Personal savings	Original copy of bank statement signed by bank official. The statement must indicate the opening date, the average balance, and the current balance of the account(s). *	US$
Parents or other family members	Signed Affadavit of Support form (print out and mail) and original copy of bank statement verifying the amount available. *	US$
Salary while on leave	Original, validated letter from employer.	US$
Government or sponsoring agency	Original or certified copy of award letter.	US$
Other sources	Validated documentation from authorized person.	US$
	Total	US$

* Bank statements must be not more than one month old.

Please fill out and mail an affadavit of support. Click for an Affadavit of Support form.

1. original (not a photocopy) financial support documents -- in English


2. photocopy of the title page of your passport - this is the page with your name and passport number on it


3. If you are under 20 years of age, an official transcript in English from the academic institution you most recently attended.



and

4. a $75 non-refundable application fee in the form of:

• a check in US dollars to the English Language Institute

  or

• direct payment by credit card (Visa or MasterCard only). Include a photocopy of your credit card with your original documents.

English Language Institute
Oregon State University
301 Snell Hall
Corvallis, OR 97331-1632
U.S.A.

To apply to the ELI on your computer, please send the completed application form with your (optional) credit card payment now. When you click on "Yes, I agree" below, you agree to the following statement:

I hereby certify that all the information on this application form is true and accurate and that the stated funds are available for my educational expenses at the English Language Institute (ELI). I will notify the ELI immediately of any changes in my financial circumstances. I understand that the submission of inaccurate information can be considered sufficient cause for rejecting my application or terminating enrollment at the ELI.