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FLS International

English Language Programs

Student Information
1 Name
Family Name(s) First Name Middle Name


Admission Application
For office use only App. #: Date Received: / / 5 Country of Citizenship 6 Country of Birth

2 Student Permanent Home Address

Street Address

7 Where did you obtain this application?

City State/Department/Province Postal Code




8 Are you a transfer student?


Yes Yes

No No

3 Gender



4 Date of Birth
Month Day Year

9 Do you require an I-20 form?

Program Selection
10 Please check program type 11 Please check the program length in weeks 1 week 3 weeks 5 weeks 4 weeks 6 weeks 2 weeks Academic English TOEIC Prep 7 weeks 8 weeks Intensive English IELTS Prep 12 weeks 16 weeks General English GMAT Prep 20 weeks 24 weeks Vacation English GRE Prep 32 weeks 52 weeks Other


12 Please check the center you wish to attend (For a list of program availability by center, review the FLS brochures or visit Saddleback College, California Las Vegas Institute, Nevada Lock Haven University, Pennsylvania Citrus College, California Boston Commons Center, Massachusetts Tennessee Tech University, Tennessee 13 Please check the date when you wish to begin January 13, 2014 April 7, 2014 February 10, 2014 May 5, 2014 March 10, 2014 June 2, 2014 June 30, 2014 July 28, 2014 August 25, 2014 September 22, 2014 October 20, 2014 November 17, 2014 December 15, 2014 Other Date
Month Day Year

Start any Monday

Housing Selection
14 Please indicate housing preference: Would you like FLS International to arrange your housing? Homestay
Please Specify*



Twin Room

Single Room

* Twin Room: Two students per room Single Room: One student per room, with other housemates in the house Twin Room Only (Citrus College, Saddleback College, Tennessee Tech University) Shared Room Only (Lock Haven University, Tennessee Tech University, and Boston Commons) Shared Room Only (Boston Commons)

Students requesting homestays are asked to complete the additional Homestay Application Form

Apartment Dormitory International House

Please note: students should arrive on the Sunday prior to their terms starting date, and leave on the Saturday after completing their program. Early arrivals and late departures should plan to stay in a hotel or be charged a daily housing rate, unless other arrangements have been made with FLS. Any student requesting housing at the International House is subject to a $385.00 cancellation fee if cancelling less than 30 days prior to the start of their program.

15 Extra Nights: $55 per night (homestay), $75 per night (apartment, dormitory, International House) Anticipated arrival date
Month Day Year

Anticipated departure date

Month Day Year

16 Health Insurance: mandatory for all students; you may purchase it in your home country. Health insurance is also available from FLS at $35 per week. Would you like to purchase health insurance through FLS? Yes 17 Would you like your I-20 Form and acceptance documents to be sent by Express Mail? Express mail delivery is available for an additional $55 fee. Note: for applications received less than three weeks prior to the starting date, the documents must be sent by Express Mail. Yes

No No

18 Would you like FLS to process the $200 SEVIS Application Fee for you? Yes Note: this is only for students who need a student F-1 visa from the US Embassy. If YES then a valid credit card must be submitted. This fee will be charged by the U.S. Government not by FLS International.


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FLS International
English Language Programs
Student Information
19 Name
Family Name(s) First Name Middle Name


Admission Application
FLS Center

20a Airport Pick-Up and Drop-Off : FLS International can provide Airport Pick-Up on the Sunday before the program starts to ensure a reliable greeting at the airport and door-to-door transportation. No Airport Pick-Up or Drop-off Needed FLS Saddleback College FLS Citrus College FLS Las Vegas Institute FLS Tennessee Tech University FLS Lock Haven University Los Angeles International Airport (LAX) Los Angeles International Airport (LAX) Las Vegas McCarran Airport (LAS) Nashville International Airport (BNA) University Park Airport (SCE) Harrisburg International Airport (MDT) Philadelphia International Airport (PHL) Boston Logan Airport (BOS) Pick-up (LAX)$150 Pick-up (LAX)$150 Pick-up (LAS)$85 Pick-up (BNA)$145 Pick-up (SCE)$85 Pick-up (MDT)$175 Pick-up (PHL)$300 Pick-up (BOS)$110 Drop-off (LAX)$150 Drop-off (LAX)$150 Drop-off (LAS)$85 Drop-off (BNA)$145 Drop-off (SCE)$85 Drop-off (MDT)$175 Drop-off (PHL)$300 Drop-off (BOS)$110

FLS Boston Commons

20b Unaccompanied Minor: Upon request, FLS will provide the name and contact information of a specific designated driver to the agent and airline for pick-up and provide chaperone service to airport security for airport drop-off. Cost is $100 round-trip. Would you like FLS to provide Unaccompanied Minor Service? Yes No Note: if you request the Unaccompanied Minor Service from your airline, you must also select this fee for FLS service.

Payment Information
21 Please send the following fees with your application: A. Application processing feerequired for all applications (non-refundable) B. If SEVIS processing is requested, payment must be included with application: US $200 (non-refundable) C. If express delivery is requested, payment must be included with application: US $55 (non-refundable) D. If unaccompanied minor service is requested, payment must be included with application: US $100
The charges listed above may be paid by travelers check, personal check, international money order, bank draft, or transfer on a USA bank. Please note that all charges must be paid in US dollars. These charges may also be paid by credit card. Only Visa, MasterCard, or American Express cards are accepted. Please do not send cash through the mail.

US $ 150 US $ US $ US $ Please Indicate Total Enclosed US $

22 Promotion Code Please mail application, fees, and a financial statement to: FLS InternationalAdministrative Offices 301 N. Lake Ave., Suite 310 Pasadena, CA 91101, U.S.A. Tel: (626) 795-2912 | Fax: (626) 795-5564 | E-Mail:

American Express
Credit Card Number


Security Code

Expiration Date


23 In case of emergency please contact:

Name Telephone

E-mail Address


24 Parental authorization for minors: (Must be completed for all students under 18 years of age) I authorize FLS International and its agents to allow any necessary and appropriate emergency medical services for my child in case of accident or illness and release them from all liability.
Signature Relationship to student (parent, guardian, etc.)

25 Financial Statement: (For F-1 visa students only) An affidavit or financial guarantee showing sufficient financial resources for the intended term of study is required from the applicant or parent. The statement should be a letter from a financial institution, government or sponsor. See schedule for approximate expenses. I understand that the approximate tuition, fees, and living expenses are US $ 2000 per 4-week term. I also realize that the tuition and fees for intended term of study are payable in full upon registration. I certify that the information shown above is true and correct:
Signature Month Day Year