University at Albany

Summer Academic Institute Application Form

Intensive English Language Program

This form may be printed and faxed or express mailed. Please print clearly or type.

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

2. Mailing Address:

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

3. I am accepted for the Fall semester at the University at Albany as a student in the following department:

Department: ________________________________

4. University at Albany ID number: ___________________________
(From your University at Albany acceptance letter.)

5. Gender:
Male Female

6. Country of Birth: ____________________________
7. Country of Citizenship: ____________________________

8. Date of Birth: Month: ________________ Day: ______ Year: ______

Please complete this SAI Application Form and return it by email, express mail, or fax. The non refundable $80 Application Fee should be in the form of a money order or bank check made out to the University at Albany. (If your application form is faxed or emailed, the $80 application fee will be added to your UAlbany bill.)

Application fee: $80

SAI Address:

Director - Intensive English Language Program
University at Albany, SUNY
Science Library G14
1400 Washington Ave
Albany, New York 12222 U.S.A.

Telephone: (518) 437-5040
FAX: (518) 591-8171