Adelphi University International General English Application

Personal details

Personal Details

As they appear on your passport

Given Name/First Name

Surname/Last Name

Gender

Birth Details

Date of Birth

Day

DD

Month

MM

Year

YYYY

City of Birth

Country of Birth

Country of Citizenship

Passport Details

Date of Expiration

Day

DD

Month

MM

Year

YYYY

Passport Number

Address & contact info

Permanent non-US home address

Street Address 1

Street Address 2

Street Address 3

City

Region/State/Province

Postal Code

Country

Are you currently living in the United States?

Address in the United States

US Street 1

US Street 2

US Street 3

City

State

Zip Code

Please enter a valid 5 digit US Zip Code.

US Mobile Phone

Area Code

US Mobile Phone

Primary Home Phone

International Code

Area Code

Telephone

Primary Mobile Phone

International Code

Area Code

Telephone

Applicant's email address

Applicant's Email Address

Emergency Contact

Given Name/First Name

Surname/Last Name

Relationship

Street Address 1

Street Address 2

Street Address 3

City

State/Province

Postal Code

Country

Email

Emergency Contact Home Telephone

International Code

Area Code

Home Telephone

Emergency Contact Mobile Telephone

International Code

Area Code

Mobile Telephone

Additional information

Form I-20

Do you have a Form I-20 from another institution in the United States?

Select “Yes” only if you are currently studying on an F1 student visa in the United States, and have been issued an I-20 document from your current institution within the United States. If Yes or Yes - Expired, please provide a copy with your application materials.

I-20 End Date

Day

DD

Month

MM

Year

YYYY

Dependents

Dependents are defined as spouses and/or unmarried children under 21.

Do you have dependents you would like to add to your I-20?

YesNo

Sponsored Students

Sponsored Students are defined as any students receiving a sponsorship from their local government, organization, or agency.

Will any part of your education be sponsored?

YesNo

Sponsorship Details

Name of the sponsor body

Name of anticipated sponsor body

Medical Insurance Requirement

I understand that I will be required to purchase medical insurance for the full duration of my program upon my arrival in the United States.

Yes

Additional Information

Upload Official English Assessment Score Report
( Language proficiency score optional)

Upload Bank Statement

Upload Passport

Additional Files (if applicable)

Declaration

I declare that the information I have supplied on this form is complete and correct. I understand that giving false or incomplete information may lead to the refusal of my application or cancellation of enrollment and/or loss of visa status.

I have read and understand the published course information in the brochure or website, and I have sufficient information about Adelphi University and General English at Adelphi International to make an informed enrollment decision.

I understand that tuition and fees may change without notice. I accept responsibility for payment of all relevant tuition and fees, and I agree to abide by the Adelphi International refund policy.

I understand that living expenses in the United States may be higher than in my own country, and I confirm that I have the financial ability to meet these costs.

I have read and understand the Enrollment Contract for Adelphi International's General English Program. I understand that the most updated copy may be found at the Adelphi International website on the link listed below:https://aui.adelphi.edu/enrollment-contract/.

NOTICE OF NON-DISCRIMINATION

Adelphi University is an equal opportunity educational institution and operates without regard to race, sex, color, age, religion, national origin, disability or veteran status. The university complies with the regulations of Titles VI and VII of the Civil Rights Act of 1964, the Age Discrimination Act, the Age Discrimination in Employment Act, Title IX of the Education Amendments of 1972, Sections 503/504 of the Rehabilitation Act of 1973, the Vietnam Era Veterans Readjustment Assistance Act, the Americans with Disabilities Act of 1990, The Equal Pay Act and the Pregnancy Discrimination Act. Anyone wishing to file a complaint covered
by the above should go to the Affirmative Action Office in Suite 005 of the Quad Center, or call 844-4794 between 7:45 a.m. and 4:45 p.m., Monday through Friday.