Date of Birth Last Name First Name Middle Name Month / Day / Year

Sex Male Female Country of Birth Country of Citizenship

Student's Permanent Home Address

AddressStreet and Building City State / Province Postal Code

Country Phone Fax Email

*Contact information MUST be the applicant’s direct contact information, not another person’s. Failure to provide the applicant’s contact information may result in delays in processing the application or denial of the application.

Mailing Address

Care of (Name of individual, relative or agency who will receive the Admissions Packet and I-20 for student.)

AddressStreet and Building City State / Province Postal Code

Country Phone Fax Email

SECTION 2: Program Dates and Costs

Put a check next to all the terms you want to attendhe semester dates you plan on attending.

SECTION 3: Visa Information

If you are not a U.S. citizen or permanent resident, you will need a student (F-1) visa in order to study full time at the International Academy.Check at least one of the following items:

I need a Form I-20 for an F-1 student visa.

I do not need a Form I-20. My visa status is:

I have a Form I-20 from USC. My major is:

My family will accompany me on F-2 visas. If more than one child, please attach additional information.

Spouse Date of Birth: Last Name First Name and Middle Name Country of Birth Country of Citizenship Month / Day / Year

Child Date of Birth:Last Name First Name and Middle Name Country of Birth Country of Citizenship Month / Day / Year

Sex: Male Female

(Must be at least 17 years old to enroll)/ /

I have a Form I-20 from another school. I want to transfer to the USC International Academy and will submit the following:1. Current Form I-20 2. Copy of I-94 Card 3. Copy of passport and visa

Name of current school

/ /

/ /

Intensive English Program (IEP) Application 2016-2017

SECTION 1: Personal Information Please print your name exactly as it appears on your passport.

Name

4. Most recent transcript from your current school

USC International Academy University of Southern California

info-international@usc.edu www.international.usc.edu

May 4, 2017 - June 16, 2017 June 26, 2017 - August 11, 2017 October 27, 2016 - April 21, 2017

October 26, 2017 - April 20, 2018

Summer Intensive English ProgramProgram Fee: $2850University Service Fee: $475

September 1, 2016 - December 16, 2016 January 5, 2017 - April 21, 2017February 23, 2017 - June 16, 2017May 4, 2017 - August 11, 2017September 8, 2017 - December 15, 2017

Intensive English Program Academic Semester Program Fee: $5700 USDUniversity Service Fee: $950 USD

Intensive English Program Extended Academic Semester

Program Fee: $8550 USD University Service Fee: $1535 USD

Friend or relative USC International Academy Website

USC Website

Educational consultant

USC department Advertisement

Internet/Website Education fair Other ____________________________________________

SECTION 7: Signatures Required to Process Information

Read the following statement carefully. Your signature indicates that you have read and understand this statement, and that you agree with it.

I authorize the USC International Academy to verify all information included in this application. I, my guardian or sponsor (as indicated below) accept full responsibility for program fees, housing, meals and any other living expenses incurred while at the Academy. I understand that Academy fees are due on or before the program start date. I have read and agree to the refund and cancellation terms on the Application Instructions.

Date

Name of Parent/Guardian Phone Number Signature of Parent/Guardian Date

Application 2016-2017

SECTION 8: Pay Fees

In order to process your application, the $175 application fee must be paid in one of the following ways:

Credit card using our online payment form here: http://international.usc.edu/fees.php Cashier's check drawn on U.S. dollars from a U.S. bank

Personal check drawn on U.S. dollars from a U.S. bank Travelers checks in U.S. dollars

Please note: Payment in cash will not be accepted for any fees. If you send a check, please make the check out to USC and write the student's name on the bottom.

Past/Current Academy Student ____________________________________________

SECTION 6: How Did You Hear About the USC International Academy?

Student Name

SECTION 4: Financial Information

Students who need a Form I-20 must provide proof of financial support, including living expenses, for the number of terms they will attend. Submit one the documents listed:

1) Bank Statement showing available funds of:

$6,497 USD$12 994 USD

$12 994 USD$25,988 USD$38,982 USD

Summer Intensive English Program One session (~ 2 months) : Two sessions (~ 4 months):

Intensive English Program Academic Semester One Semester (~ 4 months): Two semesters (~ 8 months): Three semesters (~ 12 months):

Intensive English Program Extended Academic Semester One Extended Academic Semester (~ 6 months): $19,491 USD

2) Scholarship letter from your government or sponsoring organization

If your spouse or children will accompany you on F-2 visas, add an additional $600 per month for your spouse and an extra $300 per month for each child.If bank statement is not in the student’s name, a Letter of Support must also be submitted. The letter must include the student’s name, study dates, and amount of support.

SECTION 5: Housing Request

I would like to apply for Academy Housing. YES NO

If YES, please select one of the following options and pay the $150 housing processing fee: USC Student Apartments Homestay

If you selected “YES” above, an International Academy will notify you of housing options, cost, payment information, and other important details regarding your housing.

Signature of Student

If student is under 18, please complete the section below: