Intensive English Program Application

Student Information

First (Given) Name

Middle Name (optional)

Last (Family) Name

Birthdate

Sex

Gender Designation (optional)

Personal Pronoun (optional)

Email Address

Permanent (Legal) Address in your home country
(You must provide this even if you are now in the U.S.)

Country

Street

City

Region

Postal Code

Mailing Address

Country

Street

City

Region

Postal Code

Phone Number

Phone Number Type

Country of Birth

Country of Citizenship

Are you a U.S. Permanent Resident?

Do you have a visa?

Current Visa

Visa Expiration Date

What is your intended US visa?

Application Information

Program: Intensive English Program

Term Start

To check the start dates, visit the Intensive English Program calendar.

Sponsoring Organization

Contact First Name (optional)

Contact Last Name (optional)

Contact Email (optional)

Contact Phone (optional)

Agent Information

Is an education counselor or placement agency helping you?

Yes

Company Name

Terms and Conditions

I certify that I have read and understand this form, and that the information I have provided is correct.
I understand that I am responsible for meeting all costs associated with my study at Drexel ELC and that I cannot expect to work to support my study.
I understand that all payments I make with my application are not refundable.
I understand that my application cannot be processed until I have submitted all required documents and fees.

By submitting this form with my name and the date below, I acknowledge that I have read the above terms and conditions and agree to the terms of my admission.

Student's Name

Today's Date (month/day/year)