.: I.E.I. - International English Institute :.

Last Name:
Middle Name/s:
First Name:
Your e-mail:
Current Address:
Street:
City:
State or Province:
Country:
Postal Code:
Telephone Number (Country and City code):
Street: (Permanent Home Country address)
City:
State:
Country:
Postal Code:
Telephone Number:
Name of a relative or friend living in the USA (optional):
His/her telephone number and/or email address:
Date of Birth (month/day/year):
Country of Birth:
Country of Citizenship:
Sex	female male
Date that you plan to begin your study at IEI:
Length of time you plan to study at IEI:
Plans after completing your English Study:
Do you need assistance with housing when you begin your studies in the USA?	Yes No
If so, indicate the kind of housing here and fill in the Housing Information Sheet:	Home-Stay Apartment
How did you learn about the International English Institute?	From a Placement Agency From the World Wide Web (Internet) From a newspaper or magazine advertisement From your English class in your country From a former student of IEI From any other source
Do you need a Form I-20 for a student visa?	Yes No
I certify that I have read and understand the conditions of this application, and that the information I have given is true to the best of my knowledge	Yes