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

2015-2016 Sessions

Summer I 2015, May 18 – June 19

Summer II 2015, June 22 – July 24

Fall I 2015, August 19 – October 16

Fall II 2015, October 19 – December 11

Spring I 2016, January 7 – February 26

Spring II 2016, February 29 – April 29

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

Current Mailing Address

Current City/Town

Current Country/State

Current Postal Code

Current Telephone

Current Email Address

Current Fax:

Home Mailing Address
(If different from Current mailing address above.)

Home City/Town

Home Country/State

Home Postal Code

Home Telephone

Home Email Address

Home 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?

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 (Student Visa)
F-2 (Dependent of 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.