Address in US (If known)

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Application for Admission

________________________________________________________________

1130 W Trinity Mills Rd, Carrollton, TX 75006

Office: 972-616-1197 / Fax: 972-616-1198 / www.elidallas.com

APPLICATION FEE Application fee is non-refundable

Initial______

Student Information

$310.00 Initial Student

$210.00 Transfer Student

$60.00 Just Study

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

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

(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

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: _____________________________________________________________________

_______________________________________________________________________________________________________________________________________

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

CANCELLATION AND REFUND POLICY

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.

b.

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.

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

Student Enrollment Agreement

Programs: 1) Language Program

ESL Level I____/ Level II_____/ Level III____/Level

____/ Level

____/ Level

____

TOEFL

Ⅰ ___ /

TOEFL

____/ Communication____/ Pronunciation____

--------------------------------------------------------------------------------------------------------------------------------------------------

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.

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).

---------------------------------------------------------------------------------------------------------------------------------------------------

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

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