Application Form ~ Intensive English Language Program
Summer 2004

Please print this form, complete it and mail it to Dr. Nemoianu at the address listed below.

Applicants Name:			Social Security Number:
Mailing Address:
Date of Birth:		Country of Birth:
Country of Citizenship:		Native Language:

High School: (Name)                                                         (Place)                                         (Year of Graduation)                

College Degree:  __Yes  __No                                                 Graduate Degree:  __Yes __No

After English studies, will you study for a degree?  __No   __Don't know    __Yes   __BA/BS  __MA/MS  __PhD

In what field?                                                                 At CUA?  __Yes  __No  __Don't know

Do you want to apply for an F-1 visa?  __Yes  __No  (If yes, read carefully the financial support box below.)

If you are a transfer student, name the institution that issued your I-20:                                                                                    

If you are already in the U.S.A., which visa do you have?   __F-1    __F-2   __J-1   __J-2   __B-2   
Other:                            

Financial Support Information, if you are requesting an I-20 form.

Applicants requesting an I-20 form must provide evidence of financial support for the period of study in the U.S.A.
How do you expect to pay for tuition and living expenses in the U.S.A.?

__Personal Funds	__Sponsor
__Funds from my family	Sponsor's name:

Please attach a letter of financial support from your bank, your family's bank, or from your sponsor.  The letter should be in English and should confirm that you have enough funds in U.S. dollars for the time you will study English at CUA.

Mail the Following:	To:
1. This application form. 2. An application fee (non-refundable) of $20 U.S. 3. A letter of financial support (original) and bank statement. 4. A copy of high school diploma.	Anca M. Nemoianu, Director Intensive English Program 334 Pangborn Hall The Catholic University of America Washington, DC 20064
	Telephone: 202 319-5256 Fax: 202 319-6032 Email: nemoianu@cua.edu

I certify that the information above is complete and accurate.  I understand that admission to the Intensive English Program does not constitute admission to any other program or department of the Catholic University of America.

Signature:                                                                                                                     

Date: