ELC APPLICATION FORM University of South Alabama
Print or type the following information usaesl@jaguar1.usouthal.edu  

Name_____________________________________________________________________________________
Last (family name)                    First                     Middle
Date of Birth _____/_____/_____  Country of Birth__________   Citizenship__________  Male___    Female___
month       day        year

COURSE DATE: Spring 1  [ ] Spring 2  [ ] Summer  [ ] Fall 1  [ ] Fall 2  [ ]

Jan. - Feb. Mar. - May June - July Aug. - Oct. Oct. - Dec.

Mailing Address (I-20 will be sent here)                                   Permanent Address in Home Country (if different) 
_________________________________________         _________________________________________ 
_________________________________________         _________________________________________
_________________________________________         _________________________________________
Telephone (___)___________________  Fax (___)__________________  Email ________________________
Have you graduated from high school?  0 Yes     0 No               How many years have you studied English? _____
Have you ever applied to South Alabama's ELC program before?  0 Yes     0 No           
If yes, when? Month _____, Year _____
Do you need an I-20 for an F-1 student visa?  0 Yes     0 No 
If you are now in the U.S., what kind of visa do you have?   0 F-1,   B-2, 0  J-1, 0  U.S. Resident 
0 Other ______________
What do you plan to do after studying English? 0 Study at the University of South Alabama, 
0 Return to home country, 0 Study at another U.S. university or school, 0 other _____________
How did you learn about ELC at the University of South Alabama? 
0 ELC Web site, O U.S. Information Service 
0 Advertisement (please give the publication) _________________________________ 
0 Private Advising Agency (please give name)  ____________________________________ 
0 Other ___________________________________________________________________
In case of emergency, notify:  (name, address, phone number) ________________________________________ 
_______________________________________________________________________________________
IF YOU ARE TRANSFERRING from another U.S. school, please give school name and address in the U.S. 
_________________________________________________________________________________________ 
______________________________________________School phone number (___)______________________

Signature of Applicant: I certify that the information I have given is true and correct. 

Signature                                                                                     Date

Applicants requesting an I-20 must provide evidence of financial support for the period of study in 
the U.S.  While you are studying at the University of South Alabama English Language Center, 
your support will be provided by:  HEALTH INSURANCE
Because of the high cost of health care in the United States, all students are required to purchase 
health insurance from the University.
HOUSING
Students who wish to live in a residence hall (dormitory) on campus can apply for a dormitory room after 
they arrive in Mobile.
PAYMENT PROCEDURE/REFUND POLICY
Tuition and fees are paid during registration.  Personal checks, cash, cashier's checks, bank checks, 
and Visa/MasterCard are accepted.  NO REFUND IS GIVEN AFTER CLASSES BEGIN.

APPLICATION PROCEDURE

1. Print this form.  Fill out this application form, and be sure to sign and date it.
2. Send a non-refundable application fee of $50.  It should be a U.S. affiliate bank check or                    money order made payable to the UNIVERSITY OF SOUTH ALABAMA in U.S. funds.
3. The person responsible for payment MUST

a) Complete and sign the Affidavit of Financial Support 
b) Send a letter of financial guarantee confirming that he/she has the funds necessary to pay all the living and tuition expenses in the U.S. 
4. If you are a transfer student from a U.S. university, an official from your current institution must fill out our Transfer Eligibility Form.
5. Please submit a passport-size photo with your application.

SEND TO: English Language Center, University of South Alabama 
Alpha Hall East #221 
Mobile, Alabama 36688-0002  U.S.A. 
Telephone: (251) 460-7185, Fax: (251) 460-7201

Credit card payment:  FAX ONLY if you complete this section 
To pay the application fee and housing deposit with MasterCard or Visa, complete this information: 
__MasterCard     __Visa 

Application fee          _____$50 
DHL delivery              _____      Only necessary for rush delivery of I-20. Amount depends on country.
TOTAL                       _____ 

Account number __________-__________-__________-__________      Expiration date________ 

Cardholder's name (Please print) _________________________________________________ 

Signature of authorized cardholder ________________________________________________ 

FOR SAFETY, FAX TO ENGLISH LANGUAGE CENTER AT (251) 460-7201 
DO NOT SEND THIS FORM THROUGH THE MAIL OR THE INTERNET

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