3130 Wilshire Blvd., Los Angeles, California 90010(213) 381-3710/3719, FAX (213) 381-6990
If you have problem contact us here: director@ciula-esl.org
Business Program:
Fall
Winter
Spring
Summer
Year:
ESL Program:
Term:
Date:
Mr. Mrs. Ms. Miss E-mail:
Mailing Address (USA):
Last Name:
First Name:
Middle Name:
City:
State:
Zip:
Phone:
Address (Home Country):
Street/City:
Country:
Birthday:
Marital Status:
Single
Married
Country of Birth:
Country of Citizenship:
Are you currently in the USA? Yes No
If yes, please state date of admittance into the USA
Type of Visa currently holding...............................
Visa Expiration Date..............................................
High School Graduated (Indicate city and country):
Date of Graduation:
List the names and locations of all institutions attended since high school. List in order beginning with the most recent.
1.
Name of Institution
Location
Dates
Degree earned
2.
3.
4.
5.
In which program would you like to study at California International University?
ESL TOEFL
Financial Information: A Bank Statement must be submitted
1. Please indicate the estimated funds available to you during each year you expect to be enrolled at C.I.U
U.S.$
2. From what source will you receive these funds?
Sponsor (Please fill out #3)
Personal Savings (Please fill out #4)
3. Sponsor's Name and Address
Name:
Tel. #:
Address:
4. Please indicate the name and address of a relative or close friend in the United States:
Relationship:
List three (3) personal references (United States residents)
1
Name
Address
Telephone No.
2
3
Select SUBMIT below to send the form directly to us.
Starting Dates:
Term 1 - 1/5/2009Term 2 - 3/2/2009Term 3 - 4/27/2009Term 4 - 7/6/2009Term 5 - 8/31/2009Term 6 - 10/26/2009