1

English Language Center APPLICATION FORM Government Sponsored StudentsEnglish Language Center (ELC) Michigan State University, Wells Hall 619 Red Cedar Road Room B230 East Lansing, Ml 48824 USA

If you have an MSU student number please share it with us. (PID# starts with an “A”) _____________________

Family (Last) Name____________________________________ First Name____________________________________

Date of Birth Day ______ Month ______ Year ______ Gender ___Male ___ Female

Country of Birth__________________________________________________

Country of Citizenship_____________________________________________

Native Language_________________________________Other Languages____________________________________________

International/Permanent Mailing Address

Country_______________________ Postal/ZIPCode_______________

Street Address___________________________________

City___________________________________________

PH: 517-353-0800 FAX: 517-432-1149 email: elc@msu.edu

website: elc.msu.edu

HOME phone (please include country, city and area code) ________________________________________________________

CELLPhone_____________________________________ Personal EMAIL _________________________________

U.S. Current Mailing Address (for transfer students or those already residing in the United States.)

Street Address_____________________________________________________

City _________________________________ State_______________________ Postal/Zip code_____________________

Select Semester or Program

SPRING 2020 ____16 wks (January 6 –April 24)

SUMMER 2020 ___13 wks (May 11 to August 6)

FALL 2020 ____15 wks (September 2 to December 10)

ADDITIONAL INFORMATIONAre you currently in the United States? ____YES ____ NO If you answered YES: What is your curr ent Visa status? ____F1 Visa ____J Visa ____Other

Emergency Contact Information Please provide complete information for the person to be contacted in case of an emergency.

Name______________________________________________________________________________________________

Street Address _______________________________________________________________________________________

City ________________________________ Postal/ZIP Code ____________________ Country _____________________

Home Phone (include country/city/area code) ________________________ Cell Phone ____________________________

Personal E-mail: _______________________________________________

Persons accompanying you to the United States SpouseSpouse's Family Name__________________________________ Spouse's First Name_______________________________ Spouse's Date of Birth: Day ______ Month ______ Year ______

Spouse's Native Language_______________________________ Spouse's Country of Birth__________________________

Spouse's Country of Citizenship___________________________________________________________________________

Children: Please provide the following information for each child as it appears in their passport

(for additional children, attach a separate sheet)

FAMILY name, First Name Gender Date of Birth (month/day/year)

Country of Citizenship

Country of Birth

Child’s Native Language

#1

#2

#3

Double Housing: Silver meal plan; Unlimited meals Maximum age 25

Spring and Fall full-semester single housing prices include the Silver Meal Plan. Meal plans, however, are optional. Ask the ELC about alternate meal plans. Minimum Age 21

COST CALCULATOR FOR SEMESTERS and PROGRAMS 2020 PLEASE NOTE Michigan State University and all Residence Halls are TOBACCO FREE No smoking is allowed.

Additional Housing options may be available, contact the ELC for more information.

. ADDTIONAL COSTS: Approximately $350 per semester for Books and supplies.*All students must have health insurance for the dates of their semester(s) experience.https://www.bcbsm.com/content/microsites/msu/en/index.html

HOUSING & INSURANCE THIS IS A REQUIRED SECTION Please answer the following questions to allow us to accommodate you better.

a. Would you like the ELC to help you with housing accommodations? _____Yes _____NoIf you answered no, you will need to make your own living arrangements.

b. If you answered yes to the above question, which type of student residence hall would you like?______ Single Room or _____ Double Room with single occupancy (please note there is a cost difference)

c. Would you like housing that is quiet? _____Yes _____No Preference

d. Health Insurance is required during your stay at the ELC. You must purchase coverage, including for the days youarrive before your program dates or if you travel in the US after your program finishes. https://www.bcbsm.com/content/microsites/msu/en/index.html

e. If you would like an apartment in married student housing, please refer to: http://liveon.msu.edu/apartments emailuainfo@rhs.msu.edu (Due to MSU policies, the ELC cannot reserve these type of accomodations on your behalf. You must make thesearrangements directly with livon.msu.edu or rhs.msu.edu)

f. Do you have any disabilities or handicaps that require accomodation? If YES, please explain in the box below.

g. Are there any special medical conditions or allergies you have that the ELC should know about? If yes, please explain:

APPLICATION AND FINANCIAL CERTIFICATION FINANCIAL CERTIFICATION Students accepted into the English Language Center program must provide adequate financial resources submitted in English for their period of study in the United States. (See the “Cost Calculator Per Semester”section of this application.)

I-20 FORMS Allow three weeks for processing of I-20 form.Please send the following to the Admissions Secretary at the ELC:

• This completed application form• $150 non-refundable application fee (Payment of balance (tuition) will be due no later than the day of your MSUELT test.)• Proof of financial ability and/or bank statement from your bank in English.• Copy of the information page of your passport which must include name, date of birth.

The English Language Center will process your application once all the above materials are received. After you have been accepted into our program, we will issue your I-20.

Do you wish to have the I-20 express (FedEx) mailed to you? ______YES ______ NO

If you are requesting FedEx service, remember to include the $45 FedEx fee with your application fee of $150 when you apply. (Total of $195)

4

Application Fee The enrollment fee of $150 U.S. dollars, is charged for all arrangements and shall not under any circumstances be refundable. This fee includes a $50 course fee.

Arrival Students agree to arrive before the date of the initial examination for the session to which they have been admitted.

No-Show or Withdrawal from the Language Course Should the course participant fail to show up for the language course once it has begun or withdraw from the course, he/she shall not be entitled to claim any reimbursement of payments already effected.

Deferred Enrollment Please note: Any submitted application can only be deferred for one semester (4 months). After one semester, you must submit a new application and financial statement.

Passport and Visa Requirements Many countries have Passport and Visa requirements. Please inform yourself about such regulations and take the necessary measures. We shall be happy to provide information, as needed.

Future Admission to Michigan State University While the English Language Center is located on the campus of Michigan State University, admission to the ELC is in no way related to admission to Michigan State University and does not indicate or imply any future admission to Michigan State University. Academic Admission requires direct application to the MSU Office of Admissions.

Students Seeking Government Sponsorship For those students applying for government sponsorship, if the Financial Guarantee letter from the sponsor is not submitted with a sponsored student application, the student applicant must pay the tuition and fees according to ELC Intensive English Program application procedures. Please refer to the IEP Government Sponsored application page on the ELC website for more information.

I hereby confirm that I have carefully read the General Terms and Conditions for ALL ELC Intensive English Program students as specified on the previous sheet and understand that these General Terms form an integral part of the present contract. If admitted, I agree to arrive before the date of the initial examination for the session to which I have been admitted and to comply with all regulations of the English Language Center.

Student signature ____________________________________________________________________Date ____________________________

ADMISSIONS Secretary English Language Center Michigan State University

Wells Hall B230619 Red Cedar Road East Lansing, MI 48824 U.S.A.

RequirementsApplicants must be 18 years of age or older or have graduated from high school.

Signature and address of parent/guardian is required for students under the age of 18 years old.

Name _________________________________ Signature ______________________________ Date ________________

Street name and number _______________________________________________________City ________________________

Country_______________________________________________________________ Postal/Zip code_____________________

Michigan State University is a Tobacco-Free campusThis includes Classrooms and Residence Halls

MAIL this completed form and a photocopy of your passport, along with your application fee of $150 (If you want FedExservice for your I-20 you must also add the $45 fee to your application fee for a total of $195) to the address below.

Make CHECK or MONEY ORDER payable to Michigan State University (MSU)