Academia Language School

Online Application

1. Personal Information (* Required Information)
Family Name*
First Name*
Middle Name
Sex:	Male Female
Birth Date (MM DD YY)*
E-mail*
2. Course Information
Course*	Student Visa (F1)/I-20 Course (20 hours or more) Tourist Visa/Non I-20 Course (Less than 18 hours) Kamaaina (20hr or more/week) Kamaaina (15hr/week) Kamaaina (10hr/week)
Start Date*
Length of Study
3. Personal Information - Continued
Country of Citizenship*
Place of Birth*:	City Country
Do you already have a valid F1 visa?	Yes. No, I will apply. No, I will change my status. Other
Do you have dependants who will apply for an F2 visa?	Yes No (If yes, please contact us for instructions.)
4. Transfer Students
Are you transferring from another school?	Yes No (If yes, please mail or fax a copy of your passport, I-20, and bank statement.)
School Name
Program Name
Last day of study there (MM/DD/YY)
5. Address in Home Country
Street*
City*
State/Province
Country*
Postal Code*
Phone Number
Fax Number
E-mail*
6. Current Address in the United States
Street
City
State/Province
Zip Code
Phone Number
3. Payment Information
Course Fee
I would like to pay by*
Card Holder's Name
Card Number
3-digit Verification Code
Expiration Date	/ /
4. Notes and Reminders
By submitting this application, you agree that you have read and understood the Notes and Reminders.