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AEI Virtual
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Student Application
*
required fields
Application Instructions
Download Application
Personal Information
*
Last name
*
First (given) name
Middle name
Name you wish to be called at school
*
Date of birth
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Date
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Year
1960
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1980
1981
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1989
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1993
1994
*
Sex
Male
Female
Contact Information Inside United States
Street 1
Street 2
City
State
Postal/Zip Code
Phone
Other phone
Fax
*
E-mail
Other e-mail
Emergency Contact
*
Emergency contact name
*
Emergency contact phone
*
May we use this contact for non-emergencies?
Yes
No
Attendance Plan
*
Intended start date
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Date
1
2
3
4
5
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Year
2008
2009
2010
*
Planned end date
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Date
1
2
3
4
5
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Year
2008
2009
2010
*
Initial course
-- Please Select --
Intensive Course/Program
Collegiate and Professional English (CAPE) Program
Business English
Youth Program
Tutoring
Test Preparation
*
Course times
Mornings
PM/Evenings
Goals and Academic Requirements
Please answer the following questions:
What are your short and long term goals?
Are you willing to do your part in order to succeed at the Atlanta English Institute? (Your part includes arriving on time, attending all classes, completing assigned homework, and participating fully in class.)
Yes
Other
Contact Information Outside United States
*
Street 1
Street 2
*
City
Postal/Zip Code
*
Country
*
Phone
Country of birth
*
Country of citizenship
Overseas Document Delivery Address
(Complete below only if different from address outside the United State given above.)
Street 1
Street 2
City
Postal/Zip Code
Country
Phone
Financial Information
Estimated number of months
(See attendance plan above)
Financial Information is required only for a period of 12 months or less.
(This is not an attendance limit.)
Estimated Expenses
Tuition (includes books)
$
Application Fee
$
Subtotal (tuition and fee)
$
Living expenses
$
Expenses of dependents
$
Other
$
Specify "Other"
Grand Total Expenses
$
Means of Support
Student's personal funds
$
Funds from another source
$
Specify "another source", including type
Grand Total Means
$
Entrance Category (Please check one)
Initial Entry
(coming from home country)
Transfer Student
Name of school transferring from
Date completed or will complete studies
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Date
1
2
3
4
5
6
7
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11
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21
22
23
24
25
26
27
28
29
30
31
Year
2008
2009
2010
Change of Status
Reinstatement
F-2 Dependents
Please list dependents if they will require an AEI-issued I-20 (F-2 visa)
(Use exact name as in passport)
Dependent
1
2
3
Last Name
First Name
Relationship
Date of Birth
Citizenship
*
How did you find out about the Atlanta English Institute?
Referral. Please specify
Newspaper. Which newspaper?
Internet. Please specify
Other. Please specify
Native Language
Certification
*
I certify that the information on this application is true. In addition, I have read, understood and agree to
AEI's policies
.
Yes
Comments/Other
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