Uceda International

UCEDA INTERNATIONAL | INTENSIVE ENGLISH PROGRAMS

Paterson | Passaic | Dover | Perth Amboy | New Brunswick | Lakewood | Morristown | Red Bank
Phone: (866) 823-3299 | Fax: (973) 265- 7972 | Email: studyusa@uceda.edu | Web: www.uceda.edu
Family Name:

First Name: __________ Middle Name: ________

Date of birth: Gender (Circle one): Male/ Female

Current U.S. Address:

E-mail: ___________ Phone Number:

Foreign Address:

Country of Residency: ______ Country of Citizenship: _____

Place of Birth: (city and country) ______________________

How did you hear about us? (checkonel

Qriend/Family Doster/Flyer Dewspaper _______________
Debsite __________ Oother: ________________

Desired D Paterson D Passaic DDover DLakewood DFalls Church, VA

Location: D New Brunswick D Perth Amboy DRed Bank D Morristown
Program Start Date: Program End Date:

Eng I ish Level (Estimated): D 1 D2Beginner

D3 04 Os
Advanced

QUESTIONS BELOW ARE ONLY F OR CH ANGE OF STATUS APPLICANTS

Passport number __________ Expiration date __________

Visa number ____________ Expiration date __________

Date of last entry into the US _______ Place of entry into the US _______

1-94 Form number __________ Expiration date __________

Are you currently in status in the US? ____ What is your status?

Signature Date ___________

UCEDA INTERNATIONAL IINTENSIVE ENGLISH PROGRAMS

Paterson IPassaicIDoverI Perth AmboyINew BrunswickI Lakewood IMorristown IRed Bank
Phone: (866) 823-3299IFax:(973) 265- 7972IEmail:studyusa@uceda.eduIWeb:www.uceda.edu
FINANCIAL EVIDENCE REQUIRED
IF YOU ARE USING PERSONAL FUNDS
Bank statement in your name:
showing monthly balance and deposits.
IF YOU HAVE A SPONSOR OF CASH SUPPORT
1. Sponsor’s Affidavit and Proof of Cash Support
one form for each sponsor. All questions must
be answered.
2. Bank Statement:
Showing monthly balance and deposits (if a
bank statement is in the name of more than one
person each individual must submit an affidavit
of support).
IF YOU HAVE A SPONSOR OF
FREE ROOM AND BOARD
1. Sponsors Affidavit and Proof of
Free Room and Board.
2. Copy of lease, deed, rent receipts, or
utility bill.
IF YOU HAVE A COMPANY SPONSOR
1. Sponsor’s Affidavit and Proof of Cash
Support this form may be copied for each
sponsor. All questions must be answered.
2. Business Registration Certificate
or Business Licenses.
3. Proof of Income – Profit & Loss
statement, or corporate tax return, etc.
IF PROGRAM DURATION EXCEEDS
ONE YEAR, OR FOR CHANGE OF STATUS
Then proof of income required… (one of the following)
1. Pay stubs for the last three months; or
2. Bank/investment statements for the last
three months; or
3. Income tax returns or receipts
PLEASE NOTE: All evidence must be less than
two months old (3 months for a transfer
student in good standing) Documentation
may be accepted in either English or Spanish –
all other languages require certified transla-
tion. Currency values in USD preferred but not
required. Notarization not required.

MONTHLY COSTS
ESTIMATED MONTHLY COST FOR INTERNATIONAL STUDENTS
ANNUAL COSTS
ESTIMATED ANNUAL COST FOR INTERNATIONAL STUDENTS

TUITION & FEES TUITION & FEES

Monthly Tuition: Intensive English Program Annual Tuition: Intensive English Program

Monthly Tuition: $420 Annual Tuition: $5,040

Average Fees: $40 Average Fees: $480

Total: $460 Total: $5,520

LIVING COST ESTIMATES* LIVING COST ESTIMATES*

Housing and Utilities $600 Housing and Utilities: $7,200
(based on typical (based on typical
Food: $300 cost of shared room) Food: $3,000 cost of shared room)

Transportation: $100 Transportation: $900

(Included local (Included local
Personal Item, public transit only) Personal Item, public transit only)
Clothing, other: $200 Clothing, other: $2,400

Total: $1,200 Total: $14,400

DEPENDANT COST ESTIMATES DEPENDANT COST ESTIMATES

Each dependent $500 Each dependent $6,000
(spouse or child) (spouse or child)

Total for all dependents: $ Total for all dependents: $

GRAND TOTAL: $ GRAND TOTAL: $

* Living cost estimates derived from: http://livingwage.mit.edu/counties/34023.

www.uceda.edu Tel: 866-823-3299 Fax: 973-265-7972 studyusa@uceda.edu

SPONSOR’S AFFIDAVIT AND PROOF OF CASH SUPPORT

I, , promise that I can and will give

My Full Name

no less than U.S. $

Full Name of Student

in cash support for tuition and living expenses during:

(select one)
a period of _________ months of study at UCEDA.
EVERY YEAR of the student’s program of study at UCEDA.

My relationship to the student is:

Parent, spouse, brother, sister, cousin, friend

My address is:

Telephone: Email:

The following persons are also dependent upon me for their support:

Name Age Relationship to me

Name Age Relationship to me

The name of my employer is:

Annual salary: $ (USD) Other Income: $ (USD)

I have attached the following supporting documentation:

Recent bank statement Proof of income
Other evidence:

I swear that the information I have provided above is true and correct. I am willing and able to provide
the support as outlined above, andto deposit a bond, if necessary, to guarantee that the student will
not become a public charge during his/her stay in the United States, or to guarantee that the student
will maintain his/her nonimmigrant status and will depart prior to the expiration of his/her authorized
stay in the United States.

Signature of Sponsor Date

UCEDA INTERNATIONAL | INTENSIVE ENGLISH PROGRAMS

Paterson | Passaic | Dover | Perth Amboy | New Brunswick | Lakewood | Morristown | Red Bank
Phone: (866) 823-3299 | Fax: (973) 265- 7972 | Email: studyusa@uceda.edu | Web: www.uceda.edu
SPONSOR’S AFFIDAVIT AND PROOF OF FREE ROOM AND BOARD

I, , promise that for the duration of his/her

My Full Name

study at UCEDA INTERNATIONAL,

Full Name of Student

will live free of any charge with me in my home at:

Address

Phone:
City, State, Zip

This is a property that I: own

rent

I will not require any type of service to be performed in exchange for this benefit.

My relationship to the student is:

Parent, spouse, brother/sister, cousin, friend

I have attached the following supporting documentation:

Lease / deed to prove that I am the person who owns or rents the property
Proof of income
Other evidence:

I swear that the information I have provided above is true and correct. I am willing and able to provide
the support as outlined above, andto guarantee that the student will not become a public charge during
his/her stay in the United States.

Signature of Sponsor Date

UCEDA INTERNATIONAL | INTENSIVE ENGLISH PROGRAMS

Paterson | Passaic | Dover | Perth Amboy | New Brunswick | Lakewood | Morristown | Red Bank
Phone: (866) 823-3299 | Fax: (973) 265- 7972 | Email: studyusa@uceda.edu | Web: www.uceda.edu