APPLICATION FOR INTENSIVE ENGLISH PROGRAM
Please type this form and complete all pages.
I am applying for:
Fall 20____ (September – December)
Winter 20 ______ (January – April)
Summer 20______ (May - August)
Use the name that is on your passport.
1. Last name: _______________________________________________________________________
2. First name: _______________________________________________________________________
3. Middle name: ______________________________________________________________________
4. Date of birth: _________________ 5. Country of birth: _________________5.5 City of birth: ________
6. Country of citizenship: ______________________________________________________
7. Are you a U.S. citizen? _______Yes
________No
8. Do you have a U.S. social security number? _______Yes
________No
If yes, write it here: _______________________________________________________
9. Home country telephone number: ___________________________________________
10. Cell phone number: ______________________________________________________
11. Please write your permanent, home address in your home country
Address line 1 _____________________________________________
Address line 2 _____________________________________________
Address line 3 _____________________________________________
City _________________________ Postal Code__________________
12. Email address: ____________________________________________________________________
13. Gender: ________Male
_______ Female
14. Marital status: ________single _______married
15. List any alternate name you might have:
____________________________________________________________________________________
16. If you are living in the U.S., please write your U.S. address here.
Address: ___________________________________________________________
City: ______________________________ State: __________ Zip code: __________
17. Telephone number in the U.S. (if you have one) ________________________________
18. Have you previously applied for admission to Eastern Michigan University?
If yes, what is your EMU ID number ____________________________
1
No
Yes
19. Do you need an I-20 to obtain a student visa?
Yes
No
20. If you are now in the United States, check your current immigration status:
F-1 (Student)
F-2 (Dependent)
Other (specify): ____
Permanent Resident (attach a copy of your card)
Registration A#: _______________
Effective Date: _________________
Transfer Students
21. Are you currently studying at another school in the United States?
Yes
No
If Yes, Please provide the name and phone number of the institution:
Name: _________________________________________Phone #_____________________
Address:___________________________________________________________________
City______________________State_____________________Postal Code_______________
22. If you are an F/J visa holder, what is your SEVIS N number? N______________________
23. Where did you learn about the Intensive English Program?
Friend
Advertisement (Name of publication) ______________________________________
Internet search/or specific web site ________________________________________
Travel or Study Abroad Agency ___________________________________________
Educational Fair _______________________________________________________
Other (please explain)____________________________________________________
Educational Background
24. List the last high school you attended and all colleges/universities you have previously attended or attempted
credit (list the most recent first.)
School
City/State/Country
2
Dates
Attended
month/year
Graduation
Date/Expected
month/year
25. Eastern Michigan University’s Intensive English Program application includes the following questions
regarding prior criminal convictions and/or disciplinary history, and the information provided by the student may be
considered when making the decision as to whether to admit the student to the Intensive English Program.
Question: Have you ever been convicted of a criminal offense other than a minor traffic violation, or found to be
delinquent by a juvenile court, or are there any such charges currently pending against you at this time?
Yes
No
Question: Have you ever been expelled, suspended, placed on probation, or been subject to any other
disciplinary action at any secondary school or college you have attended? Yes No
If you answer yes to either of these questions, you must submit a full statement of explanation on a separate
sheet of paper.
Eastern Michigan University adheres to the principle of equal education and employment opportunity, and
programs and activities of the University are open to all qualified persons without regard to race, gender, sexual
orientation, color, creed, national origin or disabling condition. This policy extends to all programs and activities
supported by the University.
Applicant’s statement: I certify that all information on all pages of this application is complete and accurate to
the best of my knowledge, and that I have listed all institutions previously attended. I understand that
misrepresentation or omission of any information may be cause for denial of or cancellation of admission or may
result in my being suspended or dismissed from Eastern Michigan University, if discovered subsequent. I
understand that all pertinent rules and policies of Eastern Michigan University apply to me immediately upon
admission and that it is my responsibility to become knowledgeable about them. I understand that all credentials
submitted in support of this application become the property of the University and are not returnable.
Signature of Applicant
Printed name
Date
Confirmation of Electronic Signature Agreement: By checking the referenced box, you are signing this document
electronically.
I agree my electronic signature is the legal equivalent of my manual signature on this document and I
recognize that I am legally bound by the provided information.
Type applicant surname/last name / first name _________________________________________________
Date (month/day/year) ______________________________
Supporting documents: students applying to study from overseas, please send a copy of your passport and the
$35.00 USD application fee.
For students applying from an institution in the U.S., please send a copy of your passport, visa, I-94, current I-20
and the $35.00 USD application fee.
Please submit all application documents to:
Eastern Michigan University
English as a Second Language Office
317 King Hall
Ypsilanti, MI 48197- USA
esl@emich.edu
734-487-0338
www.emich.edu/esl
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APPLICATION FOR INTENSIVE ENGLISH PROGRAM
Financial Statement of Responsibility
Surname/last name: ______________________________ First name: _______________________________
Will you bring dependents (a husband/wife and/or children)? ________ yes ________ no
If you are bringing dependents, you must include a copy of the passport of each dependent and complete the
information below:
Last name
First name
Relationship
to applicant
Date of birth
City of birth
Country of
birth
Country of
citizenship
Estimated Costs
Estimated costs include tuition and fees, transportation, books, room and board and mandatory health
insurance. Costs are for one academic year using current school year rates. Amounts are shown in United States
Dollars (USD) for minimum full-time enrollment. Please complete the cost estimate below.
Intensive English Program Tuition
$40,000
Health Insurance (optional) spouse
$5,750
Health Insurance (optional) per child
$2,834
Living expenses for each family
member
Total USD for I-20 Eligibility
$6,325
$40,000
$
International applicants must submit an official bank statement with original/live signatures providing proof of
liquid funds equal to or exceeding the “Total USD for I20 Eligibility” above. The bank statement can be mailed to
the address below or dropped off in the ESL Program office, 317 King Hall. NO FAXES, SCANS or
PHOTOCOPIES of bank statements will be accepted. If the name on the bank statement is NOT the applicant,
please have the sponsor fill out the Financial Affidavit of Support.
Mailing address for all financial documents:
ESL Program
317 King Hall
Ypsilanti, MI 48197
USA
Note for SACM students: all financial guarantees must be submitted in one of the following ways: a PDF file from
a SACM advisor, an email from a SACM advisor, or an original delivered in person or by mail. Email copies from
applicants and fax copies cannot be accepted.
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APPLICATION FOR INTENSIVE ENGLISH PROGRAM
Financial Affidavit of Support for Issuance of Form I-20 or DS-2019
Each individual who will contribute financially to the names student’s education must complete this form and
submit an official, dated bank statement. Please indicate the student’s name on all financial documents.
Student Surname/last name: _____________________________ Student first name ______________________
EMU ID: _______________________________
Part 1:
Name of Sponsor ___________________________________________________________________________
Relationship to Student _______________________________________________________________________
Sponsor Mailing Address ______________________________________________________________________
_______________________________________________________________________
Phone __________________________ email __________________________________
I/We guarantee to provide financial support in the amount of $_____________________ (US dollars) for the
student’s (and dependents, if applicable) tuition, fees, and living expenses in order to study at Eastern Michigan
University. As verification that funding is available, I have provided an original bank statement(s).
Confirmation of Electronic Signature Agreement: By checking the referenced box, you are signing this document
electronically.
I agree my electronic signature is the legal equivalent of my manual signature on this document and I
recognize that I am legally bound by the provided information.
Sponsor full name __________________________________Date (month/day/year) ____________________
Part 2:
Requirements for all official documentation of funds

An official, dated bank statement must be provided

All accounts must be easily accessible and liquid assets

All documents must be in English or an English translation must accompany the original document

Letters of sponsorship must include exact dollar amount of support (in US dollars) and dates of sponsorship
The following documents are NOT acceptable:

Statements verifying employment and salary

Insurance premium and policies

Property or personal assets

Lines of credit

Assets like stocks, bonds, equities, retirement accounts

Income tax returns
Official documents must be mailed to:
ESL Program, Eastern Michigan University, 317 King Hall, Ypsilanti, MI 48197, USA
esl@emich.edu
www.emich.edu/esl
734-487-0338
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