Conditional Admission Application Form

University at Albany Intensive English Language Program

This form may be filled out and printed. Please print clearly or type.

1. Name (as it appears on your passport): 
Family name: 
Given Name: 

2. Permanent Address in Your Country (REQUIRED) This must be the address of the STUDENT:

Address:
Address:
City:
State:
Country:
Postal Code:
Student Phone:
Student Email address (required):

3. Agent Address (If applicable):

Agent Name:
Agency Name::
Address:
Address:
City:
State:
Country:
Postal Code:
Agent Phone:
Agent Email address:

4. Temporary Mailing Address (If applicable):

Address:
Address:
City:
State:
Country:
Postal Code:
Phone:
Email address:

5. Country of Birth: 

6. Country of Citizenship: 

7. Date of Birth: 
Month:  Day:  Year: 

8. Sex: 
Male  Female

9. Marital Status: 
Single  Married

10. Have you taken the TOEFL or IELTS? 
No  Yes Score: 

11. Highest Degree Completed: 
High School  University (Undergraduate)  University (Graduate)

12. Which semester do you plan to begin study at the Intensive English Language Program: 
Fall 
Spring 
Summer 
Year 

13. How long do you plan to study in the Intensive English Language Program? (The normal length of study is 1 year.) 
1 year (Recommended)  Fall only (16 weeks) 
Summer only (8 weeks)  Spring only (16 weeks)

14. Do you need an I-20 for an F-1 Student Visa? 
Yes  No 
If no, what is your Visa type or U.S. resident status? 

15. Date you expect to arrive in the United States.: 

16. Do you want to live in a University Residence Hall (Dormitory) on campus? 
NOTE: Space in the dorm is limited in the Fall semester. Apply early. 
Yes 
No

17. Do you plan to remain in the U.S. for academic study after completing your program at the IELP? 
Yes  No

18. Are you transferring from another school in the United States? 
Yes  No 
If yes, name of school and program: 
Phone number of school: 
Current school transfer form required

19. How did you learn about IELP? 

I understand that I am required by the United States Government to have the necessary funds for the program for which I am registering at this university. I have the required funds available.

Signature of Applicant: 

Date: 

Print this application.

Mail the following items:

Mail to:

*Make international money or or bank check payable to the UNIVERSITY at ALBANY


Financial Statement

The United States Government requires all foreign students applying for an F-1 Visa (student visa) to furnish proof of sufficient funds for the cost of their studies and living expenses in the United States.

To receive an I-20 form, you must complete the financial statement on the application form and attach a statement from your bank on original letterhead. No faxes or photocopies.

Total Amounts Required for F-1 Students:

Period of study Amount of funds to verify
1 year 1-20 (recommended) $22570
Summer only $11285
Each dependent $4000

 

Name and Address of Self or Parent (or Name and Address of Supporting Agency or Sponsor):
Name:
Address:
Address:
City:
State:
Country:
Postal Code:
Phone:
Relationship to student
(family, relative, friend, etc.)

I certify that I am aware of the costs for the Intensive English Language Program at the University at Albany, State University of New York. I further certify that I fully understand that I must pay tuition on the first day of the session. Room and board, comprehensive fees, and medical insurance are payable to the University after my arrival.

Signature of Parent (or Signature of Applicant): 

Signature of Applicant: 

Date: 


Attach to this application an original statement from a bank that verifies that you, your sponsor or your sponsoring organization have sufficient funds to pay all of your expenses. Attach a photocopy of the picture page of your passport.