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Intensive English Program Application

Applicant Information

  Fields marked with ** are required.

** Name: 
(as on passport) Last/Family Name Given/First Name Middle Name

** Phone Number:    ** Email Address:   

** Gender:
 
** Date of Birth:
Month
/
Day
/
Year
*The minimum age
for attending the
ELI is 17 years.

** Home Address: 
(including country)
 


Mailing Address: 
(if different, for mailing
immigration documents)

** City/Country of Birth:    ** Native Language:   
** Country of Citizenship:    Other Languages: 


Are you Hispanic or Latino? (optional)  
       
Ethnicity: (optional)
 


VISA Information

** Please check one:







.


Study Plans

** When will you being your studies at the ELI? Please choose one session.
   Note: Application deadlines are only for students who will apply for an F-1 visa.




** How long do you plan to attend the ELI IEP?





** Do you want to study  

What are your plans after studying with the ELI IEP? (mark all that apply):








Educational Record

** Secondary School Name: 
** School Location (city, country): 
** Graduation Date:
/
Month
  Year


College or University Name (if applicable): 
College or University Location (city, country): 
Major Field of Study: 

What is your status at this college or university?
 Years of college or university experience:
 Graduation Date: 
/
Month   Year


Have you taken the TOEFL or IELTS?
    Most Recent Score:



Additional Information

** Mark the number showing your opinion of your English ability (1 for absolute beginner, 10 for native-like)
    


Do you want to live on campus at UAB?



How did you hear about us?







Certification

Please read the following statements carefully. By clicking SUBMIT below, you will indicate that you have read and understood these statements and that you agree with them.

  • All of the information that I have given in this application is correct to the best of my knowledge.
  • I understand that neither acceptance to the English Language Institute nor completion of its curriculum will guarantee or influence admission to the other programs at the University of Alabama at Birmingham.
  • I understand that my placement within the ELI IEP curriculum will be determined by the ELI administration.
  • I give the English Language Institute permission to send information about my English language proficiency to my sponsoring agency (if any) and to the proper UAB officials if I apply for admission to a UAB academic program.




Please click only once.