Application Form
Print out form and type or print clearly		 English Language Institue
George Mason University
Phone (703) 993-3660
Fax (703)993-3664
http://eli.gmu.edu
Family Name: ____________________________________________________

First Name:    ____________________________________________________

Middle Name: ____________________________________________________ 

 Male:  _____

Female: _____

Date of Birth: _________________
Month     day   &nbspyear 
Country of Birth:     ____________________________________

Country of Citizenship: _________________________________ 

 U.S. Social Security Number: _____________________
if you have one 

          Session you want to start attending: 
Fall 20___      Spring 20___      Summer 20___ 
Foreign Address: ___________________________________________________________________
                                                                                          street and number

                         __________________________________________________________
                                                 city                                    state or province                                           country 

                                 Telephone: ___________________________ 
If the applicant or a friend, relative or sponsor of the applicant has a U.S. address please complete the following:

U.S Address: ___________________________________________________________________
                                                                                          street and number

                         __________________________________________________________
                                                 city                                    state                                           Zip Code 

                                 Telephone: ___________________________ 

To which address should the ELI send information and documents?   Foreign address ___   U.S. address ___ 

Do you need a Form I-20 for a student visa?   Yes: ___   No: ___
If you answered "yes" to the last question, you must fill out the financial statement that follows, as required by the U.S. Department of Homeland Security.

Do you plan to bring any dependents with you to the U.S.?   Yes ___   No ___
If you answered "yes" to the last question, you must complete the Dependent Information section that follows.

Do you want information about university housing?   Yes ___   No ___

If you are now living in the U.S., indicate your visa type:   F-1___  J-1___  A-1___  G-4___   B-2___   immigrant___   other___

Have you attended any school in the United States?   Yes___   No___
If yes, from (dates)__________ to __________
Please give the name and address of the school:_______________________________________________

_____________________________________________________________________________________

Do you plan to study at a university in the United States after ELI study?   Yes____   No___   at George Mason___  other___

Major field of study intended after ELI study: ____________________________________

How did you learn about the ELI?   Friend or relative___   U.S. Embassy or consulate___   ELI website___

Advising center           other__________________________________________
                                                             please write in your answer

I certify that the information I have provided is correct and complete and that I have read the English Language Institute policies and understand the terms.

_____________________________________________________________________________________________
             applicant's signature                                                                                                                                   date

Financial Statement
Fill out this form if you need a student visa and if you will be sponsored by someone other than yourself.

You will need approximately $13,300 U.S. when you arrive at George Mason University to cover six months of expenses: tuition, books, fees, food, housing, and personal care items.
If you are bringing dependents, you will need an additional $2,500 for your spouse and $1,250 for each child.
Parent's/Sponsor's Name: _____________________________________________________________________
                                                                      last or family                                    first                                           middle 

Parent's/Sponsor's
Address:                        _______________________________________________________________________
                                                                                                 street and number

                               ___________________________________________________________
                                                               city                                               state or province                                           Country 

Sponsor's relation to applicant: _______________________________________ 
 

I guarantee financial support of
(minimun $13,300) $_____________ for _____________________________________________________
                                                                                                                     student's name 

__________________________________________________________________________________________
             sponsor's signature                                                                                                                      date 

Dependent Information
Complete the following chart with information about dependents of the F-1 student who are seeking entry/reentry to the U.S.
Family/Last Name First Name Date of Birth Country of Birth Relationship to F-1 Student

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Send the completed application with required documents and a $75 check or money order payable to George Mason University to:

English Language Institute
MSN 4C4
George Mason University
Fairfax, VA 22030-4444
U.S.A.

Pagemaster: Laurie Miller/llmiller@gmu.edu/revised November 13, 2006