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Mail, Scan or Fax completed application to:
American Language and Culture Institute
333 S. Twin Oaks Valley Road
San Marcos, CA 92096-0001
Tel: 760.750.3200
Fax: 760.750.3779
alci@csusm.edu
www.csusm.edu/alci
HOW TO APPLY: Use the separate “ALCI Application Checklist” to make sure your application is complete. All documents must be in English. I-20s
cannot be issued for incomplete, illegible, or unsigned applications. Applications that are missing documents or fees cannot be processed.
Applicants should be 18 years of age or high school graduates. If you are under 18, a parent or sponsor must co-sign your application.
A. PERSONAL INFORMATION Print clearly. Do not use abbreviations.
Complete legal name, as it appears in your passport:
1.
____________________________________________________________________________________________________________________
Family Name
First Name
Middle Name
2.
4.
Male
Female
Date of Birth: ___________________________
(mm/dd/yyyy)
3.
Student’s E-mail:
5.
Country of Birth: ___________________Country of Citizenship: ___________________
PERMANENT RESIDENCE ADDRESS OUTSIDE THE UNITED STATES
6.
7.
____________________________________________________________________________________________________________________
Address
____________________________________________________________________________________________________________________
City
Province
Postal Code
Country
Telephone: ______________________________________
8. Fax: ______________________________________
Country Code/Area Code/Number
Country Code/Area Code/Number
Mailing address if different (to send documents)
9.
OR
I will pick up my documents from ALCI
____________________________________________________________________________________________________________________
Address
____________________________________________________________________________________________________________________
City
Province
Postal Code
Country
B. PROGRAM CHOICE
1.
You want to enroll in:
Intensive Academic Preparation (IAP)
2.
Date you want to start : _____________
3.
You are applying for conditional admission to CSU San Marcos
_________________________
I plan to study:
Semester at CSU San Marcos
1 term
Yes
1.5 terms
2 terms
Other: ___________________________
2.5 terms
3 terms
Not sure
No If yes, what do you plan to study?
Conditional admission applicants who start the ALCI on a 2nd entry start date must pay tuition and fees for minimum 1.5 terms before enrolling in ALCI classes.
4.
You are currently attending (or have previously attended) another college/university____________________________________________
College/University Name and Country
C. HOUSING See the ALCI website before you choose. Students must make their own housing arrangements before the semester begins.
Homestay
Apartment
Other: (Please be specific.)________________________________________
Campus Housing - University Village Apartments (UVA) or The Quad. ONLY available for students who enroll in the ALCI at the beginning of the
semester, not second entry students. Apply early. Campus Housing fills up VERY quickly.
*The following link has details about housing options: http://www.csusm.edu/alci/housing/index.html
D. HOW DID YOU LEARN ABOUT OUR PROGRAMS? Please check all that apply.
Friend/family member
Advisor/Counselor/Agent
Other:
Magazine or printed guide (name): __________________________________
Internet (website name): ___________________
E. SIGNATURE Your application cannot be processed without a signature!
I certify that all application information is true. ____________________________________________________________ Date: ______________
Signature of Applicant (Parent or guardian must sign if under18)
(mm/dd/yyyy)
F. FOR REFERRING AGENCY ONLY
Agency Name:
Phone:
Contact Name:
Fax:
Email:
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G. I-20 APPLICATION Do you need an I-20 for an F-1 student visa or school transfer?
Yes – Complete this section
No- Skip this
1. TOTAL AMOUNT NEEDED: Show the total amount for your entire period of study up to one year. See ALCI Application Checklist,
“How Much Money Will I Need” to estimate the cost. Total amount needed $ _____________________
2. SOURCE OF FUNDS:
Personal/own
Parent/Relative
Other (specify)
3. OFFICIAL BANK VERIFICATION OF FUNDS You must submit a bank statement, printed in English, indicating the amount of funds available to
you or ask your bank to complete this section. If you are sponsored by a company or organization, submit a letter of sponsorship on letterhead.
Name of account holder:
Official Bank
Name of Bank:
Stamp or Seal
Bank Location: (city & country)
Amount of available funds (must equal or exceed the total amount in item 1 above): $
Date: (mm/dd/yyy)
Name of Bank Official:
Title of Bank Official:
Signature of Bank Official:
4. STATEMENT OF FINANCIAL SUPPORT
The person who is financially responsible for you must read and sign the following statement: I have read the information regarding the cost of tuition
and living expenses for the period of study at CSU San Marcos/ALCI. I certify that these funds are available and I accept full responsibility for these
expenses. I fully understand that persons coming to the U.S. as students are expected to study full-time and no student should expect to work.
Name of Person Financially Responsible (Print):
Relationship to Student:
Signature:
Date:
5. FAMILY MEMBERS/DEPENDENTS: List all family members who will come to the U.S. with you. Send a passport copy for each individual.
________________________________________________________________________________________________________________________
Family name
First name
Date of Birth (mm/dd/yyyy)
Country of birth
Relationship to you
________________________________________________________________________________________________________________________
Family name
First name
Date of Birth (mm/dd/yyyy)
Country of birth
Relationship to you
H. PAYMENT AMOUNT
The ALCI application fee must be paid before the I-20 is issued. Payment of tuition for the first term of study is recommended. If you do not receive a
visa, we will refund the tuition payment in full. Application fees are non-refundable. I am enclosing the following amounts with my application:
$150 ALCI application and express mail fee ONLY
$300 Conditional Admission application fee, includes ALCI
Required for all general ALCI applicants
Application fee. Required for all conditional admission applicants.
Full tuition $ ____________
$55 CSUSM Application fee required for conditional admission applicants
(send a separate check to “CSUSM” or pay online)
TOTAL amount you are sending: $ _________________
I. PAYMENT METHOD
1.
I have enclosed a check, money order, or bank draft in the amount of $_________________ in U.S. dollars payable to “CSUSM ALCI”.
Bank drafts and money orders must be drawn on a U.S. bank or a U.S. branch office of your bank. Do not mail cash.
2.
I will pay by credit card:
Credit card number:
Name on credit card:
Visa
-
MasterCard Total to be charged $ ___________________
-
-
Expiration date:
Security code (last 3 numbers from the back of the credit card):
Billing Address:
3.
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
City
Province
Postal Code
Country
*REQUIRED* Authorized Cardholder signature:
4.
I will send a wire transfer. (Please contact alci@csusm.edu for instructions.)
The ALCI is a division of California State University San Marcos Extended Learning
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Updated on 3/20/13