IIE Application

The information you provide in this application will assist IIE in placing you into an intensive English program for Fall 2013 and subsequently an academic program. You may be required to provide additional information at a later date in order to secure admission into a specific academic program. This application and any supplementary documents must be sent to BSWBapp_Fall@iie.org. Personal Information Full Name: (As you reported it to CAPES) Surname:
(Exactly as it appears on your passport)

___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

Jose Erisvaldo Lessa Vieira

Given Name:
(Exactly as it appears on your passport)

Gender: CPF:
(Cadastro de Pessoa Fisica):

Masculino

___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

04464142478 16/01/1982

Date of Birth: City of Birth:

(Exactly as it appears on your passport)

Country of Birth: Country of Citizenship: ___________________________________________ Country of Dual Citizenship:

(Only if applicable)

___________________________________________ ___________________________________________

Country of Permanent Residence:

Telephone Number: Email Address:

___________________________________________ ___________________________________________ ___________________________________________

Demographic Information (Optional) Please indicate below how you identify yourself (a sua cor ou raa): Amarela Branca Indgena Parda Preta

Academic Information TOEFL/IELTS/ITP Exam Date: _______ Exam Date: _______ Field of Study / Major: ___________________________________________ Entrance Year: ___________________________________________ Current Semester: ___________________________________________ Anticipated Graduate Date:
(Month/Day/Year)

Score: _____________ Score: ______________

___________________________________________ ___________________________________________

Name of University in Brazil: Last day of current semester classes: ___________________________________________ Last day of current semester exams: ___________________________________________ Courses: Please list the courses that you would like to take during your academic program in the United States. You should include a brief description of the course(s).

Course Title

Brief Description

Research: Please list 1-2 research topics you are interested in within your field of study:

1. 2. Supplemental Documents Please send a copy of the following supplemental documents with your application: Passport: A copy of the biographical page of your passport. If you currently do not have a valid passport, you must apply for one immediately. Your application will be pending until we receive a copy of your passport that is valid until September 2014. Transcripts (Histrico Escolar) from your current college or university in Brazil with an English translation: Your transcript should include the name of the courses, when they were taken and the grades you received. Students CANNOT translate their own transcripts. Unofficial transcripts will not be accepted by universities in the United States. An official translation is one that is completed by a skilled translator who is able to provide an accurate and complete interpretation of the original transcript. IIE recommends that students ask a university or college official to translate and stamp the documents with a signature or institutional seal. IIE will also accept translations completed by the EducationUSA office. You should consult an EducationUSA Advisor regarding the translation of your documents. 2 Instructor Evaluations: These forms should be completed by a teacher or professor at your university or college in Brazil. A copy of the form is attached with this application. Copy of your TOEFL, IELTS, or ITP score report: A screenshot or other image of the score you received on your TOEFL or ITP test. Official TOEFL, IELTS or ITP Score Report: You must order an official score report be sent directly to IIE from ETS if you took the TOEFL IBT. You can request that this document by sent to IIE by going on the ETS website and ordering a copy be sent to institution code 2326, undergraduate. IIE is listed under Institute of International Education. If you took the IELTS, please contact the British Council and ask that they send it to Institute of International Education, C/O Nick Savot, 809 UN Plaza, New York, NY 10017, USA. If you took the ITP exam, please check with CAPES.