________________________________________________________________
1130 W Trinity Mills Rd, Carrollton, TX 75006
Office: 972-616-1197 / Fax: 972-616-1198 / www.elidallas.com
Initial______
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How did you learn about our school? ______________________Referred by ELI student: Name: __________________________
Date of Birth: ______/______/______
Family Name First Name Middle Initial
Gender:

Male

Female Country of Birth: ___________________ Country of Citizenship: _________________
Address in U.S (If known): ____________________________________________________________________________________
___________________________________________________________________________________________________________
Telephone Cell Phone Fax E-mail
Emergency Contact Information: ______________________________________________________________________________
Person’s Name Telephone Number
Dependent Information: How Many? ________ 1) Name: __________________ Date of Birth : ____/____/____
2) Name: __________________ Date of Birth : ____/____/____ 3) Name: __________________ Date of Birth : ____/____/____
Address in home country : ____________________________________________________________________________________
Street City State or Province
___________________________________________________________________________________________________________
Country Postal Code Telephone
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Date you wish to begin at ELI: 2014 (Students can register at the beginning of each month)
Term
I
(January 5-Aril 24) Term
II
(May 4-August 21) Term
Ⅲ
(August 31-December 18)
January 5 February2 March 2 March 30 May 4 June 1 June 29 July 27 August 31 September 28 October 26 November 23
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Optional Services
Airport Pick – Up Service? ___ Yes ___ No ___I do not have my flight information. I will inform ELI as soon as possible.
I have my flight information: Arrival Date: _________ Time: _______a.m. / p.m. Airline: _______________ Flight #: ___________
Housing Placement Service? ___ Yes ___No If yes, how long do you plan to stay? _________ Type:

Home stay

Apartment
Please list any health problems, allergies or food you cannot eat: _______________________________________________________
Please state any other comments or preference: _____________________________________________________________________
_______________________________________________________________________________________________________________________________________
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Statement of Financial and Health Responsibilities
I acknowledge that I have read, understand and agreed to the terms in this application. I certify that I will be fully responsible for all expenses, including but not limited to school, living and medical expenses, while attending ELI. I also agree to accept full responsibilities for my actions while participating in the Program and any related activities, including but not limited to, excursions and agree to assume responsibilities for all injuries that may occur from my participation. In case of illness and/or injury, permission is granted to any appropriate medical center for examination and/or treatment and/or referral to outside physicians.
__________________________/_____/______________________________________________________________/_____/____
Signature of Applicant Date Signature of Parent or Guardian if Applicant is under 18 Date
Page 1 of 3 Elite Language Institute, LLC

Refund Due Dates:
1. If an applicant never attends class (no-show) or cancels the contract prior to the class start date, all refunds due will be made within forty-five (45) calendar days of the first scheduled day of class or the date of cancellation, whichever is earlier.
2. For an enrolled student, the refund due will be calculated using the last date of attendance (LDA) and be paid within forty-five (45) calendar days from the documented date of determination. The date of determination is the date the student gives written notice of withdrawal to ELI or the date that ELI terminates the student due to the student’s failure to adhere to the institution’s attendance, conduct, or student progress policy.
Cancellations:
Non-Refundable Charge Definition: Application/Registration Fees, Courier Fees, VISA Change Process Fees, SEVIS I-20 Fees, Book/Supply
Fees, Reinstatement Fees and any other government fees (non-refundable charges are listed in the enrollment agreement).
1. Rejection of Applicant: If an applicant is rejected for enrollment or if a prospective student has his/her visa application rejected, a full refund of all tuition monies paid, less non-refundable charges, will be made.
2. Program Cancellation: If ELI cancels a program subsequent to a student’s enrollment, all monies paid by the student will be refunded.
3. Cancellation Prior to the Start of Class or No Show: If an applicant accepted by ELI cancels prior to the start of scheduled classes or never attends class (no show), ELI will refund all monies paid less a maximum total of $500 of identified non-refundable charges. a.
For an enrollment of less than 12 weeks, all the tuition charges for up to four weeks of the first term/session, and a maximum total of $500 for non-refundable charges will be made. b.
For an enrollment of 12 weeks or more, all the tuition charges for up to six weeks of the first term/session and a maximum total of $500 for non-refundable charges. c.
Initial students entering the US with an I-20 issued from E.L.I. who do not enroll, forfeit the first month’s tuition of $650 and will not be refunded the application fee of $310.
Withdrawal or Termination After Start of Class:
1. The institution is not obligated to make refunds to students who are terminated due to violation of ELI’s written disciplinary and/or attendance policies or local, state, or federal law.
2. For students who withdraw at any point in the first four weeks, ELI may retain charges applicable to the first four weeks. Students who withdraw after the first four weeks but before or at the mid-point of the term, ELI may retain a prorated amount of tuition. For students who withdraw after the midpoint, the institution may retain all of the charges for that term.
3. Refunds will be calculated and pro-rated on a weekly basis. When determining the number of weeks, the institution will consider a partial week the same as if a whole week were completed, provided the student was present at least one day during the scheduled week.
Charges Other than Tuition:
All extra costs, such as books, supplies and any similar charges not included in the tuition, will be clearly stated as non-refundable
charges in the enrollment/application documents. Such charges are not subject to the refund computation.
I have read and understood the cancellation and refund policy and this was made clear to me before I entered the United States and/or enrolled at E.L.I.
Signature
/ /
Date

Page 2 of 3 Elite Language Institute, LLC Updated on 3/16/2015
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Programs: 1) Language Program
ESL Level I____/ Level II_____/ Level III____/Level
Ⅳ
____/ Level
Ⅴ
____/ Level
Ⅵ
____
TOEFL
Ⅰ ___ /
TOEFL
Ⅱ
____/ Communication____/ Pronunciation____
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Monthly Tuition: $650.00 / $500.00 Books: $45.00 / $50.00 / $60.00
Miscellaneous Fees: $ _______ (For_______________________________________________)
Effective Date: Enrollment is effective on _____/_____/_____
TOTAL COST : $ _________
Method of Payment: Please check one.
Cash_____/Check_____/Cashier Check_____/Money Order_____/Other_____
Credit Card #: _______________________________ EXP. Date: _____/_____

All costs, class meeting times, and locations are subject to change.
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Payment will be made in full before the start of the first day of class. No interest is charged.

Please see our tuition policy on our website: www. elidallas.com
Non-Refundable Charge Definition: Application/Registration Fees, Courier Fees, VISA Change Process Fees, SEVIS I-20 Fees, Book/Supply
Fees, Reinstatement Fees and any other government fees (non-refundable charges are listed in the enrollment agreement).
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Elite Language Institute, LLC will give equal opportunity to all applicants regardless of race, sex, or natural origin. Approved
and regulated by the Texas Workforce Commission, Career Schools and Veterans Education Department, Austin, Texas,
ACCET and SEVIS. I have received a copy of this enrollment agreement and the catalog.
Initial ______
▷
I understand that as a transfer student I am enrolling for a 4 month term and I am financially responsible for paying for the
term in full, even though ELI allows for monthly payments. Student Initial _____
▷
I understand that as an initial student I am enrolling for a 6 month term and I am financially responsible for paying for the
term in full, even though ELI allows for monthly payments. Student Initial _____
▷
I understand it is my sole responsibility to maintain my status by following all applicable school policies and state and federal
laws. Student Initial _____
__________________________________________________________________________/____/____
Signature of Student Printed Name of Student Date
_________________________________________________________________________/____/_ ___
Signature of Authorized School Official Printed Name of Authorized School Date

(PDSO or DSO) Official
Page 3 of 3 Elite Language Institute, LLC