University of Evansville : Intensive English Center Application

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Intensive English Center Application

How to Apply:

NOTE: If you want to apply for both Intensive English and undergraduate study, then please use the International Student Application.

If you want to apply for only Intensive English, then continue with the following:

Be sure you have examined the Intensive English Program costs.
Read and complete all the parts of the Intensive English Center Application below.
Be sure to indicate if you want to reserve a residence hall room.

Intensive English Center Application

Please select ALL the sessions you plan to attend:

Summer I 2008, May 19 – June 20	Summer II 2008, June 23 – July 25
Fall I 2008, August 20 – October 17	Fall II 2008, October 20 – December 12
Spring I 2009, January 4 – Februrary 27	Spring II 2009, March 9 – May 1

Do you plan to apply for a residence hall room?

Yes No
If yes, do you smoke? Yes No

First Name

Middle Name

Last Name

Gender

Male Female

Present Mailing Address

Present City/Town

Present Country/State

Present Postal Code

Present Telephone

Present Email Address

Present Fax:

Permanent Mailing Address
(If different from present mailing address above.)

Permanent City/Town

Permanent Country/State

Permanent Postal Code

Permanent Telephone

Permanent Email Address

Permanent Fax Number

Date of Birth: (mm/dd/yyyy)

Country and City of Birth

Country of Citizenship

Marital Status

Single Married

If your spouse and/or children will accompany you, please provide their name(s) and dates of birth.

Spouse:
Children:

Where did you hear about the University of Evansville Intensive English Center?

For how many years have you studied English?

Number of Years:
When? Where?

Have you taken a TOEFL test?

Yes No

If yes:
Type?
Paper-based
Computer-based
Internet-based

When Taken?

Score?

After English studies will you:

Return Home
Study for a Degree

If studying for a degree, what level?

B.A./B.S. M.A./M.S. Ph.D.
Major:

Would you like an application for undergraduate admission to the University of Evansville?

Yes

Do you plan to apply for a student visa?

Yes No

Are you now in the United States?

Yes No

If yes, what type of Visa do you already hold?
(You must complete this part.)

A-1 or A-2 (Diplomatic)
B-1 or B-2 (Tourist)
J-1 or J-2 (Exchange Visitor)
Institution that Issued your DS-2019:

F-1 or F-2 (Student)
Institution that Issued your I-20

Other (e.g., Permanent Resident)

Do you have medical insurance?

Yes No

Name of Insurance Company:

Full-time students must have medical insurance which meets the university's requirements. Students on an F-1 visa may purchase an insurance policy through the university upon arrival.

I certify that the information provided is accurate and complete. I understand that admission to the Intensive English Center does not constitute admission to the University of Evansville.

Yes, I agree to the terms above.

The University of Evansville operates under a non-discriminatory policy with regard to race, color, age, religion, disability, sex and national origin.

Please report any website problems via our Contact Form. For all other inquiries, please email admission@evansville.edu.