University at Albany State University of New York

Intensive English Language Program Application Form

Please carefully fill out the following information. We will use this information to create your University at Albany
and SEVIS records. Be sure that all information is accurate and that all statements are true.

* Required
Todays Date

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Please verify the 8-week session you want to apply for. Click here to see session dates.*
I am applying for the following session:*
Choose an item.

FAMILY NAME exactly as it appears on your passport: *

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GIVEN NAME exactly as it appears on your passport: *

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MIDDLE NAME exactly as it appears on your passport:

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PERMANENT ADDRESS in your country. (This must be the home address of the student.) *
Enter Permanent Address line 1 *
Enter Permanent Address line 2
Enter Permanent Address City and State *
Enter Permanent Address Postal Code and Country. *

PHONE NUMBER (Including country code):

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EMAIL ADDRESS: *
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AGENT NAME:
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AGENT ADDRESS (if applicable):

Enter Agent Address line 1
Enter Agent Address line 2
Enter Agent Address City and State
Enter Agent Postal Code and Country

AGENT PHONE NUMBER:

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AGENT EMAIL ADDRESS:
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SEND ACCEPTANCE PACKET TO THE FOLLOWING ADDRESS:

Permanent Address
Agent Address
Other
Enter Other Address Line 1.
Enter Other Address Line 2.
Enter Other City and State.
Enter Other Address Postal Code and Country.

COUNTRY OF BIRTH: *
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COUNTRY OF CITIZENSHIP: *
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DATE OF BIRTH: *
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GENDER: *
Male
Female

HIGHEST DEGREE COMPLETED: *

High School
University (Undergraduate)
University (Graduate)
Other Click here to enter text.

Do you need an I-20 for an F-1 Student Visa? *

Yes
No
If no, what is your Visa Status? Enter your Visa Status.

How long do you plan to study at the Intensive English Language Program? *
One 8-week session
One semester (two eight-week sessions)
One year
Other: Click here to enter text.

Approximate date you expect to arrive in the U.S.:

Click here to enter a date.

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

TOEFL Score Enter TOEFL Score here. IELTS Score Enter IELTS Score here

Are you transferring FROM another school in the U.S.? *

Yes
No

TRANSFER INFORMATION
Answer this section ONLY if you answered YES to the previous question.

Name of the SCHOOL and PROGRAM that you are transferring from?
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PHONE NUMBER of the school you are transferring from:

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EMAIL ADDRESS of the school you are transferring from:

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Do you understand that you must send a current transfer form?

Yes

How did you learn about IELP?

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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 email or mail a statement from your bank on original letterhead to:

Intensive English Language Program

Science Library G-40
University at Albany
1400 Washington Ave
Albany, NY 12222 U.S.A.

Email: ielp@albany.edu

Amount Required for F-1 Students:

$6500 for the requested session.

$2000 required for each dependent I-20.

Do you understand that you are required by the United States Government to have the necessary funds for the
program for which you are registering at this university? *
Yes
Do you (or your sponsor) have the required funds available? *
Your sponsor is the person who will support you financially while you study in the U.S.
Yes
Other: Click here to enter text.

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. *
I, the student, so certify.
I, the sponsor, so certify.

Who will support you financially? *

You (the student) or your sponsor must provide a bank statement.
I, the student, will support myself.
My sponsor will support me.

SUPPORTING SPONSOR INFORMATION

Answer this section ONLY if you answered MY SPONSOR WILL SUPPORT ME in the previous question

NAME of SUPPORTING SPONSOR

The sponsor is the person who will financially support the student. It could be a parent or another sponsor.
Click here to enter text.

SPONSORS RELATIONSHIP to the STUDENT

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ADDRESS of SUPPORTING SPONSOR

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DEPENDENT INFORMATION
Do you wish to bring a dependent (spouse/child) with you to the U.S.? *
A separate I-20 form is issued for each dependent. There will be a $30 charge for each dependent. Please include
all extra charges with your application fee.
Yes
No
Unsure

Fill out this section ONLY if you answered YES to the previous DEPENDENT question.

Carefully fill out all information for each dependent.

A separate I-20 form is issued for each dependent.
There will be a $30 charge for each dependent.
Please include that amount in your application fee.
Be sure to verify $2000 for each dependent in your financial statement.

*All information is required for each dependent.

Dependent Family Name Given Name and Date of Country of Country of Gender Relationship
Middle Name Birth Birth Citizenship To Student

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FINAL INSTRUCTIONS

Step 1: Save this form and email or mail it to IELP.

Step 2: Email or mail 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.

Step 3: Email or mail a photocopy or scan of the first page of your passport so that we can verify the spelling of
your name.

Step 4: Mail the $130 application and Express Mail fee in the form of a money order payable to "University at
Albany" to the following address:

Intensive English Language Program

Science Library G-40
University at Albany
1400 Washington Ave
Albany, NY 12222 U.S.A.

Email: ielp@albany.edu

Telephone: (518) 437-5040

FAX: (518) 591-8171

* If you wish to pay the application fee by credit card or international wire transfer, please email ielp@albany.edu
for instructions.

YOUR APPLICATION WILL NOT BE COMPLETE UNTIL WE RECEIVE THE BANK STATEMENT, PASSPORT COPY AND
THE APPLICATION FEE.

When we receive your application, financial statement, passport copy and application fee, we will send you an I-
20 Form (Immigration and Naturalization Certificate of Eligibility). You will need the I-20 Form in order to receive
an F-1 student visa at the U.S. Consulate/Embassy in your country.

Thank you for applying to the University at Albany Intensive English Language Program. We look forward to seeing
you soon.