American Collegiate Summer Registration Form 

Personal Details
As they appear on your passport



Birth Details
Date of Birth

DD

MM

YYYY




Permanent non-US home address








Address in the United States






Please enter a valid 5 digit US Zip Code.
US Mobile Phone


Primary Home Phone



Primary Mobile Phone



Applicant's email address

Emergency Contact











Emergency Contact Home Telephone



Emergency Contact Mobile Telephone



Applicant Information




Academic Details

 


 

 

English Proficiency
Official exam results must be provided.

Date Taken or Scheduled

DD

MM

YYYY


Date Taken or Scheduled

DD

MM

YYYY


If you answered "Yes" to this question, please submit a copy of the English exam results with your application.


Education Status


Disciplinary History
Please note that if new circumstances alter your status at the school or in your community after you submit this application, you are required to notify American Collegiate Summer as soon as possible.






An affirmative response to any of the above questions will not automatically prevent admission, but any omission or falsification is grounds for denial, rescission of admission, or expulsion.

Form I-20

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




Medical Insurance Requirement

Additional Information





Declaration
NOTICE OF NON-DISCRIMINATION

American Collegiate Summer does not discriminate on the basis of race, creed, color, marital status, sexual orientation, gender identity, gender expression, religion, sex, national origin, age, mental or physical disability, or veteran’s status in our programs and activities and provide equal access to our programs and activities.