Applications received by e-mail will be processed, but responses and documentation will be kept in the Intensive English Language Program office until the necessary documents and application fee are received.
              

       (  )  Fall Semester, 2008 (September-December)                                       (  ) Spring Semester, 2009 (January-May)

       (  )  Fall I, 2008 (August 27-October 17)                                                       (  ) Spring I, 2009 (January 7- February 27)

       (  )  Fall II, 2008 (October 22-December 12)                                                (  ) Spring II, 2009 (March 4- May 1)

 

 

 

 

Please print or type the following information:

NAME                              __________________________________________________________________
                                             Last/Family Name                              First                            Middle

ADDRESS                        __________________________________________________________________
                                             Address

                                 ___________________________________________________________________________
                                   City                              State/Province                       Country                  Postal Code
 

TELEPHONE __________________ FAX _____________________   E-MAIL______________________

GENDER (  ) Female (  ) Male               DATE OF BIRTH _______/________/________ 
                                                                                                             Month         Day              Year

COUNTRY OF CITIZENSHIP_________________COUNTRY OF BIRTH ___________________

(     )  NO U. S. VISA YET                 CURRENT U. S. VISA STATUS  ___________________

Are you currently in a ESL Program in the United States?  (  ) Yes (  ) No

       If "Yes," please provide the following information:

 __________________________________                 ______________________
      Name of School                                                                                  Dates of enrollment

     _________________                     ____________________       _________________________________
     Telephone Number                            FAX Number                                 E-mail address

Marital Status   ( ) Single  ( ) Married   Will your spouse and/or children accompany you?  ( )YES  ( )NO

If "Yes," on a separate sheet, please indicate the name(s), date(s) of birth, place(s) of birth, and relationship(s) to you of each person accompanying you.

Do you plan to apply for admission to Temple University when you finish language studies

If  "Yes", will you apply as an (  ) undergraduate or a (  ) graduate student? What will your major be?______________________

(  )  I want to live with an American family. Please send me a Host Family application form.
(  )  I prefer to make my own arrangements to live off-campus.

PLEASE ENCLOSE THE FOLLOWING MATERIALS WITH YOUR APPLICATION:

(  ) Application Fee: Check for U.S.$50.00 made payable to Temple University and drawn on a U.S. bank.  This fee is non-refundable.  No cash will be accepted as payment.
(  ) Completed and signed FINANCIAL CERTIFICATE  (unsigned forms are not acceptable)
(  ) ORIGINAL BANK CERTIFICATION OF AVAILABILITY OF FUNDS (no less than US$9500.00 and in English) DATED NO MORE THAN 6 MONTHS BEFORE THE START DATE OF THIS PROGRAM

All the information I have supplied is true to the best of my knowledge.  I understand that any omission or misrepresentation will prevent me from being admitted to the Intensive English Language Program. I also understand that admission to the Intensive English Language Program is not admission to undergraduate or graduate degree programs of Temple University.

_____________________________________        ___________________________________
Signature                                                                                        Date