ELS USA Application Form 2023 - Final
ELS USA Application Form 2023 - Final
ENGLISH EDITION
In order for your application to be processed, you must include a non-refundable application fee AND a c Application fee
tuition prepayment with your application form (see 2023 Prices and Dates).
c Tuition prepayment
Permanent Address
40 bis Makanza kimbangu kalamu
Street Address
Kinshasa Kinshasa Democratic republic of Congo
City State/Province Country Postal Code
+243815142945 [email protected]
Telephone Email
Street Address
Telephone Email
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2 Programs, Locations and Start Dates
While all programs run in 4-week sessions, students can start on any Monday
year-round (Tuesday if Monday is a public holiday). For the best experience
we encourage students to start at the beginning of a session where possible
and not to start on week four of the session.
Schedule A
Programs............................................................................................................................................................................................................................................
❏ Intensive English (30 lessons/week) ❏ Semi-Intensive English (20 lessons/week) ❏ American Explorer (15 lessons/week)**
❏ Other: ______
Locations ...........................................................................................................................................................................................................................................
❏ Cincinnati, OH ❏ Nashville, TN
❏ Cleveland, OH ❏ New York, NY (Manhattan)
❏ Houston, TX ❏ Philadelphia, PA
❏ Melbourne, FL ❏ St. Petersburg, FL
Schedule B
Programs............................................................................................................................................................................................................................................
❏ Intensive English (30 lessons/week) ❏ Semi-Intensive English (20 lessons/week) ❏ American Explorer (15 lessons/week)**
❏ Other: ______
Locations ...........................................................................................................................................................................................................................................
❏ La Verne, CA ❏ Tampa, FL
❏ St. Paul, MN
*All centers in the USA offer Intensive English, Semi-Intensive English, and American Explorer (Except ELS/Tampa doesn't offer American Explorer and ELS/Chicago offers only Intensive Online English Program).
** A Form I-20 is NOT available for the American Explorer program.
***If you have requested an I-20, you will need to provide financial documentation to cover your tuition, fees, and living expenses for the number of weeks selected.
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3 Centers and Accommodations
Schedule A
Weeks of Housing*.............................................................................................................................................................................................................................
❏ 4 weeks ❏ 8 weeks ❏ 12 weeks ❏ 16 weeks ❏ 20 weeks ❏ 24 weeks
*Must not exceed number of weeks of booked study. A $600 housing reservation fee is required to confirm your reservation.
Schedule B
Weeks of Housing*.............................................................................................................................................................................................................................
❏ 4 weeks ❏ 8 weeks ❏ 12 weeks ❏ 16 weeks ❏ 20 weeks ❏ 24 weeks
❏ Other: ____________ ❏ I do not need ELS housing
*Must not exceed number of weeks of booked study. A $600 housing deposit fee is required to confirm your reservation.
*Off-campus student residence bookings are handled through ELS. Prices are subject to change, and special deposits and cancellation policies may apply. Please see Prices and Dates for additional details.
x=Not applicable
*Housing and room type availability is subject to change.
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4 Homestay Accommodations
Will you accept children under age 6 in the home? ❏ Yes ❏ No Will you accept a host with a dog? ❏ Yes ❏ No
Do you smoke? ❏ Yes ❏ No Will you accept a host with a cat? ❏ Yes ❏ No
Will you accept a host that permits smoking? ❏ Yes ❏ No Will you accept a host with other pets? ❏ Yes ❏ No
Do you drink alcoholic beverages? ❏ Yes ❏ No Do you have any medical conditions or allergies? ❏ Yes ❏ No
Will you accept a host that permits alcohol? ❏ Yes ❏ No Do you have any dietary restrictions? ❏ Yes ❏ No
Please specify any medical conditions, allergies, or dietary restrictions
you have:
5 Visa Information
Do you need a Form I-20?* ❏ Yes ❏ No If a transfer is needed, please provide the name of the institution
from where you are transferring:
If YES, do you need: ❏ Initial I-20? or ❏ Transfer I-20
Please list any dependents (spouse or child) who will travel with you to the USA and require an F-2 visa. (If listing more than TWO, please include a separate page.)
Date of Birth Country of Birth City of Birth Date of Birth Country of Birth City of Birth
Please provide a copy of your biographical page from your passport, plus a copy of the biographical page from the passport of each dependent.
* Form I-20 is NOT available for the American Explorer program.
6 Additional Services
Would you like ELS to arrange airport pickup service upon your arrival?* ❏ Yes ❏ No
All ELS students must have health insurance valid in the U.S.A. If you cannot ❏ Yes ($200 per four-week course) ❏ No
provide proof of your own insurance in English, you must enroll in the ELS
Student Health Plan. Would you like to purchase the ELS Student Health Plan?
* See 2023 Prices and Dates for the fee for the center you selected.
7 Academic Goals
Do you plan on attending a US university or college after studying English at ELS? ❏ Yes ❏ No
If no, what is your goal for learning English with ELS? ________________________________________________________________________________________________________________
If you answered yes, have you already been accepted to a US institution? ❏ Yes ❏ No
If you answered yes, please write the name of the university or college where you have been accepted: _ _______________________________________________________________
Additionally, please provide a copy of the acceptance letter, if available, with your application.
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8 Emergency Contact
Please provide contact information for a person ELS can reach in case of an emergency.
X P.MPOTSH 08/09/2023
Signature of Applicant Date
X
Signature of Parent or Guardian if Applicant is under age 18 Date
10 Payment Information
All payments must be made in US dollars.
Do not send cash. ELS accepts payment by money order, check (drawn on a US bank), travelers checks, and credit cards.
Payment Worksheet
Application Fee: ______________________________________________ ($180)
Tuition Payment: ______________________________________________ See 2023 Prices and Dates document for details.
Housing Reservation Payment: __________________________________ See 2023 Prices and Dates document for details.
Airport Pick-Up Fee (if requested): ________________________________ See 2023 Prices and Dates document for details.
Total Fees Due: _______________________________________________ (Includes application fee)
Balance of fees must be paid before or upon arrival at center along with a $27.50 non-refundable materials and technology fee plus a $15 facilities fee for each week of study for eligible programs.
Would you like to pay by credit card? Contact [email protected] and a member of the Admissions team will send a link to secure payment options.
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2023 IMPORTANT INFORMATION
c Completed health form (if applicable) Tuition Fee Tuition fees are as listed in the 2023 Prices and Dates document. You
Proof of medical insurance (if not purchased through ELS) must pay the tuition for all booked weeks before starting your program at ELS.
All fees are to be paid in full for your entire course of study when you register. Facility Fee The $15 Facility Fee is assessed at the beginning of each week for all
ELS works with many counseling agents around the world who can provide you with students at campus-based centers. This fee is used to cover the student’s access to
information and assistance. Select ELS agents are authorized to collect monies on behalf facilities on campus. The available facilities will vary by location but often include the
of ELS. If the agent who assists you has such an arrangement with ELS, any refund for library, fitness center, and parking. The Facility Fee is required by all ELS centers except:
which you may be eligible may be coordinated with this agent. New York - Manhattan. This fee is non-refundable.
Instructional Hours Student Health Plan Fee All ELS students must have medical insurance. The
The Intensive English program consists of the equivalent of 30 instructional lessons per week Student Health Plan is offered to ELS students at a non-refundable fee of $50 per week.
(six and a half lessons per day Monday through Thursday, and four lessons on Friday). The
Semi-Intensive program consists of 20 instructional lessons per week (four lessons per day Booking ELS Housing At the time of submission of a housing request, ELS will
Monday through Friday). The American Explorer program consists of 15 instructional lessons require a reservation fee of $600 to confirm the housing reservation. This fee will be
per week (three lessons per day Monday through Friday). The Intensive Online English+ applied toward the housing balance. Any remaining balance will be due upon arrival at
program consists of 18 instructional lessons per week (three lessons per day Monday the center.
through Friday). The first day of each four-week course may be devoted to placement and
evaluation, registration, and other non-instructional activities. The final Thursday of each Airport Pick-Up Fee ELS airport pick-up service is an optional service to all ELS
session is devoted to student testing and counseling. The last day of each four-week course students for an additional fee. In order to secure airport pick-up, ELS must receive flight
may be devoted to graduation ceremonies and non-instructional activities. details, arrival times, and drop-off location at least 7 days prior tostudent’s arrival. No
refunds will be granted for airport pick-up if flight details are not received at least 7 days
prior to arrival.
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Cancellation and Refund Policy
Tuition and Fees
If ELS does not accept your application, ELS will refund you the application fee, as well as If you withdraw after completing at least 50% of your booked course, you will not be
any tuition collected. Tuition payment for your entire booked course is required prior to eligible for a refund.
attendance and is subject to the cancellation and refund policies stated below. If you extend the length of your booked course and withdraw from the course before
completing 50% of the extended portion of your booked course, you will be eligible for a
Tuition and Fees Cancellation Policy* prorated tuition refund of the booked extension. This refund will be calculated from your
If ELS accepts your application, but you cancel your booked course, the application fee will last recorded day of attendance and will be calculated by week based on the weekly price
not be refunded. However, should you cancel your booked course, you may apply your for the actual length of your extended study. ELS counts any part of the week that you
application fee toward a new course for up to 12 months after your initially scheduled studied as a full week of attendance for refund calculations.
start-date. If you extend the length of your booked course and you have completed 50% or more of
If your visa application is rejected or you cancel your booked course prior to the start date the extended portion of the booked course, you will not be eligible for a refund.
and you have not entered the U.S.A. on a student visa sponsored by ELS, ELS will refund all
tuition and fees (except the application fee and express mail fee). Program Changes
If you enter the U.S.A. on a student visa sponsored by ELS and cancel your booked There is a one-time $150 program change fee if you change your enrollment from the
course or do not report for class, ELS will retain the first four weeks of tuition as a non Intensive English program to the Semi- Intensive or American Explorer program after your
refundable fee if you have a booked course of four or eight weeks. first four weeks of enrollment. No program changes are permitted within the first four
weeks of a booked course.
Tuition and Fees Refund Policy* Housing Cancellation and Refund Policy
Standard Programs (Intensive English, Semi-Intensive English, American Explorer, ELS kindly requests that should a student wish to cancel or defer, we are notified as soon
Intensive Online English+) as possible. If notified at least 14 days prior to the arrival, the housing reservation fee will
be refunded in full. If notified less than 14 days prior to the arrival, the fee is non-
If you withdraw during the first four weeks of your booked course, ELS will retain the first
refundable. In the case of a visa denial, ELS will refund the $600 reservation fee upon
four weeks of tuition and fees as a non-refundable fee. You will be eligible for a prorated
receipt of a visa denial letter.
tuition refund on any remaining weeks of your booked course. This refund will be
calculated by week based on the weekly price for the actual length of study.
All Refunds
If you withdraw after the first four weeks of your booked course and have not completed
at least 50% of your booked course, you will be eligible for a prorated tuition refund. This Refunds will be made within 30 calendar days of your notice of cancellation or withdrawal
refund will be calculated from your last recorded day of attendance and will be calculated from the program. ELS follows all applicable state and federal regulations, including those
by week based on the weekly price for your actual length of study. ELS counts any part of related to student refunds.
the week that you studied as a full week of attendance for refund calculations. All refunds are processed in the same method in which payment was originally received.
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2023 PRICES AND DATES
Health Insurance
$50 Semi-Intensive English 20 4 $1,660
(per week)
2023 Tution by Program All tuition for the booked course must be paid prior to class attendance.
Semi-Intensive English $1,660 $3,320 $4,680 $6,240 $7,300 $8,760 $9,660 $11,040 $12,420 $13,800 $15,180 $16,560
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2023 HOUSING AND AIPORT PICK-UP FEES
Schedule A
Airport Pickup
Minimum Age
Minimum Age
Minimum Age
Price per Week
Airport Code
Occupancy
Occupancy
Availability
Availability
CENTERS
$250 EWR
New York (Manhattan) X X X X X X X X X X $375 7 18 $215 JFK
$215 LGA
Schedule B
Meals per Week
Airport Pickup
Minimum Age
Minimum Age
Minimum Age
Price per Week
Airport Code
Occupancy
Occupancy
Availability
Availability
CENTERS
Schedule A Schedule B
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