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    Application
    (Students who do NOT require F1 Visa)
    *  required fields Download Application

    Personal Information
     
    * Last name 
    * First (given) name
      Middle name
      Name you wish to be called at school
    * Date of birth  
    * Sex Male Female
     

    Contact Information
     
      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?YesNo
     

    Attendance Plan
     
    * Intended start date
    * Planned end date
    * Initial course
    * Course times MorningsPM/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
    * 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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