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American Language Center

Your English Connection to the World

2014 Enrollment Application

Mail or email all documents to: UCLA Extension 10995 Le Conte Avenue Room 139, Main Cashiers Office Los Angeles, CA 90024, U.S.A. For questions, please contact the American Language Center Phone: (310) 825-9068 Email: alcenroll@uclaextension.edu

application@uclaextension.edu

UCLA Extension American Language Center 2014 Important Reminders

Here is a list of important issues to keep in mind as you complete the enrollment application. Please follow all directions carefully. If you have questions or concerns, please contact the American Language Center (ALC) by phone at (310) 825-9068 or by email at alcenroll@uclaextension.edu, and we will be happy to assist you. 1. M  inimum Age: You must be at least 18 years of age on or before the start of the program you wish to enter. For example, for a program beginning on June 25, 2014, your date of birth must be on or before June 25, 1996. 2.  Student (F-1) Visa: If you are coming from another country to study in a full-time ALC program, you will need a student (F-1) visa. Tourist (B-1/B-2) visas are not acceptable for full-time ALC intensive English programs, regardless of the program length. 3.  Family Members Who Also Wish to Study Full-Time: If family members are coming with you to the U.S., and they also want to study fulltime in the U.S., they will need to submit enrollment applications and obtain student (F-1) visas. 4.  Student and Exchange Visitor Information System (SEVIS) Fee: Once you receive your ALC admission documents and I-20, you must pay the SEVIS fee. The SEVIS fee must be paid and recorded in SEVIS before your visa interview. We strongly recommend that you pay the fee online at www.fmjfee.com. You will find complete information on that website. 5. O  btaining an F-1 Visa: For information on the visa interview, visa application fees (MRV fees), and F-1 visas, check with the U.S. Embassy or Consulate in your country. 6. Housing Options: Information is provided on our website at uclaextension.edu/alc. A.  Off-campus, Non-UCLA Housing: All off-campus, non-UCLA housing reservations, contracts and arrangements are made between the students and the housing providers and are not the responsibility of the American Language Center. You must make housing payments to the off-campus, non-UCLA housing provider directly. The UCLA Extension American Language Center cannot process these payments. B.  On-campus, UCLA Summer Housing: UCLA on-campus housing is available for our summer programs only. The 2014 housing fees were not available when this application was published; however this information should be available in early 2014. For information about UCLA on-campus housing, please contact the UCLA Extension American Language Center. 7. P  ayment: Credit card payments are preferred in all circumstances. Although we will process your initial enrollment application once we have received the application fee, your enrollment will not be complete until you pay the program fee and student services fee. Please keep this in mind if you are applying for more than one program. Programs may fill up before the payment deadline (on page 3), and we cannot reserve your space without full payment. A.  Nonrefundable Application Fee: The nonrefundable $150 application fee must be paid before you submit your application. This payment is valid for one year. B. Program Fee and Student Services Fee: Both fees are mandatory for all students. 8. Refunds: For information about refunds, see the Cancellation, Refund, and Transfer Policy on page 7. 9. Late Arrival Deadlines: All students must arrive by the first Friday of the program in order to attend. 10. Please bring the following on the first day of the program: One official passport-sized (3.5 cm x 4.5 cm) or smaller photo for your ALC student identification card Passport A copy of your I-20 with the U.S. port of entry stamp Your local address in Los Angeles

UCLA Extension American Language Center 2014 Deadlines

Applications are accepted until programs are full. Applying before the deadline will improve your chances of getting a space. We recommend allowing at least 1.  8 weeks to obtain an F-1 visa. 2.  Although we will process your initial enrollment application once we have received the application fee, your enrollment will not be complete until you pay the program fee and student services fee. Please keep this in mind if you are applying for more than one program. Programs may fill up before the payment deadline, and we cannot reserve your space without full payment. 3. The nonrefundable $150 Application Fee must be paid before you submit your application. This payment is valid for one year. 4. The Program and Student Services Fees are mandatory for all students.

Winter 2014
Program Program Dates Recommended Total Program & Application Student Services* Submission Date Fees Due AIEP January 6-March 14 November 1 1, 2013 $5,285 IECP - 12 January 6-March 27 November 1 1, 2013 $6,480 IECP - A January 6-January 30 November 1 1, 2013 $2,350 IECP - B February 4-February 27 December 9, 2013 $2,350 IECP - C March 3-March 27 January 6, 2014 $2,350 Check, Credit Card, and/or Money Order Payments Due By December 16, 2013 December 16, 2013 December 16, 2013 January 20, 2014 February 17, 2014 Check, Credit Card, and/or Money Order Payments Due By March 17, 2014 March 17, 2014 March 17, 2014 April 14, 2014 May 12, 2014 Check, Credit Card, and/or Money Order Payments Due By June 9, 2014 June 9, 2014 July 21, 2014 June 16, 2014 July 14, 2014 August 1 1, 2014 Check, Credit Card, and/or Money Order Payments Due By September 15, 2014 September 15, 2014 September 15, 2014 October 13, 2014 November 10, 2014 Bank Wire Transfer Payments Due By November 25, 2013 November 25, 2013 November 25, 2013 December 16, 2013 January 20, 2014 Bank Wire Transfer Payments Due By February 17, 2014 February 17, 2014 February 17, 2014 March 17, 2014 April 14, 2014 Bank Wire Transfer Payments Due By May 12, 2014 May 12, 2014 June 23, 2014 May 19, 2014 June 16, 2014 July 14, 2014 Bank Wire Transfer Payments Due By August 18, 2014 August 18, 2014 August 18, 2014 September 15, 2014 October 13, 2014

Spring 2014
Program Program Dates Recommended Total Program & Application Student Services* Submission Date Fees Due AIEP March 31-June 6 February 3, 2014 $5,285 IECP - 12 March 31-June 19 February 3, 2014 $6,480 March 31-April 24 February 3, 2014 $2,350 IECP - A April 28-May 22 March 3, 2014 $2,350 IECP - B May 27-June 19 March 31, 2014 $2,350 IECP - C

Summer 2014
Program Program Dates Recommended Total Program & Application Student Services* Submission Date Fees Due AIEP - A June 23-September 12 April 28, 2014 $5,680 AIEP - B June 23-August 1 April 28, 2014 $2,980 AIEP - C August 4-September 12 June 9, 2014 $2,980 IECP - A June 30-July 24 May 5, 2014 $2,350 IECP - B July 28-August 21 June 2, 2014 $2,350 IECP - C August 25-September 12 June 30, 2014 $1,870

Fall 2014
Program Program Dates Recommended Total Program & Application Student Services* Submission Date Fees Due AIEP September 29-December 5 August 4, 2014 $5,285 IECP - 12 September 29-December 18 August 4, 2014 $6,480 IECP - A September 29-October 23 August 4, 2014 $2,350 IECP - B October 27-November 20 September 1, 2014 $2,350 IECP - C November 24-December 18 September 29, 2014 $2,350

Credit Card payments are recommended and must be made online at uclaextension.edu. If sending payment by check, please make payable to the Regents of U.C. We recommend that checks be sent by DHL, FedEx, UPS, or another express mail courier well in advance of the payment deadline. UCLA Extension Cashiers Office Attn: ALC 10995 Le Conte Avenue, Room 139 Los Angeles, CA 90024 Please contact the American Language Center at alcenroll@uclaextension.edu if you would like to pay by bank wire transfer. Specific documents must be submitted in order to pay by bank wire transfer. *Student Services Fee includes: Injury and Sickness Insuranceallows students to visit a hospital or clinic if medical attention is needed due to an injury or sickness (Please note: insurance prices are subject to periodic increases, and permanent residents of the United States will not be eligible for this insurance) Academic Advisingquarterly orientations regarding American universities, UCLA Extension certificate programs, and assistance with application procedures and forms Language/Computer Labup to 8 hours per week of extra, after-school access to state-of-the-art language practice, email, and internet Housing Detailsinformation is provided about finding a place to live (Please note: UCLA on-campus housing is available for intensive programs in the summer only. Prices for 2014 summer on-campus housing have not yet been determined. Please look for detailed summer housing information and pricing in early 2014.) Language Exchange Programopportunities to meet members of the local community and UCLA for conversation practice UCLA Recreation Facilitiesaccess to many of UCLAs outstanding sports and recreational facilities Express Mailapplication and program materials sent via express mail

UCLA Extension American Language Center 2014 Enrollment Application Checklist

Age & Visa Requirements: Students must be at least 18 years of age by the program start date. The American Language Center (ALC) full-time Academic Intensive English Program (AIEP) and Intensive English Communication Program (IECP) require an F-1 student visa. Tourist visas (B1/B2) are not acceptable for full-time ALC intensive English programs, regardless of program length. Please follow the steps below carefully so that we can process your application and issue an I-20 document.

Enrollment Steps: Email the below items as PDF files to application@uclaextension.edu.

u 1.  Application Form: Complete the application form (pages 5 and 6). Indicate your program selection by marking the program(s) and session(s) you will attend. Please type or print clearly in blue or black ink. u 2. P  ayment: Go to uclaextension.edu to pay. The nonrefundable $150 application fee is required before you submit your initial application; program and student services fees are due for new students by the payment deadline on page 3. Continuing students must pay program and student services fees when submitting the application to be enrolled. Please follow these payment instructions: uclaextension.edu/applyfees. u 3.  Enrollment Confirmation: Please submit a copy of the Enrollment Confirmation with your application. You will receive an Enrollment Confirmation with your student ID number by email once you have paid. Please add your student ID number to page 5 of your application. u 4.  Passport Copy: Make a clear, readable copy of your passport page showing your name, date of birth, passport expiration date, and photograph. If your spouse (husband or wife) and/or children will come with you on an F-2 visa, please also include a clear copy of your spouses/dependents passport page(s). u 5. Financial Certification  ponsor Statement (must be in English)can be filled out in section 4A of the application form or attached as a separate document. A. S B.  Verification of Bank Funds (must be in English)can be filled out in section 4B of the application form or attached as a separate document.

(Both A and B must be dated within 60 days from the date your application is received.) 6. Transfer Students: This section is only for F-1 students transferring from another school in the United States. Please also submit: u A.  An official American Language Center SEVIS Transfer Form signed by the school you have been attending (with the beginning and end dates of attendance and your SEVIS I-20 release date). Please contact ALC for the form. u B. A copy of your most recent I-20 u C. A copy of your F-1 visa and your spouses/dependents F-2 visa u D. A copy of your I-94 card or a copy of your electronic I-94 form (www.cbp.gov/I94).  ull payment of application, program, and student services fees (Please follow the payment instructions in step #2 if you have not u E. F yet paid.)

We look forward to welcoming you! If you have questions, we will be happy to assist you. Please contact us at: American Language Center UCLA Extension 10995 Le Conte Avenue, Room 614 Los Angeles, California 90024-1333 U.S.A. Phone: (310) 825-9068 alcenroll@uclaextension.edu Website: uclaextension.edu/alc Facebook: facebook.com/alcucla

UCLA Extension American Language Center

2014 Enrollment Application
To complete your enrollment, please submit this application, payment, and all documents from the checklist as PDF files to application@uclaextension.edu
For Representatives/Agencies Only: Customer ID:_______________ Agreement No.:______________________ Agency Name: __________________________________________________ Representative Name: ____________________________________________ Representative Email:____________________________________________ u Student will pay. Please do NOT issue an agency invoice. u Agency will pay. Please issue an agency invoice. Is this a group enrollment? u Yes u No

1. Student ID Number:_____________________________________

Name of Group: _________________________________________________ Your student ID number is listed on the Enrollment Confirmation that is emailed to you after you pay online. Please do not submit your application without your student ID number. Keep a copy of the Enrollment Confirmation for future reference.

Print your name exactly as it appears on your passport.

Family Name (Surname/Family Name as shown on your passport) First Name (Given Name as shown on your passport) Middle Name

Student Email Address (this email address must be used when paying online) _____________________________________________ Date of Birth (Month/Day/Year): ____________________ u Male u Female 2.  Program Selection: Please mark the program(s) that you want to attend. Next to each fee listed below, you will see a Project ID number. Pay online by entering the Project ID number in the Quick Enroll section of the UCLA Extension website. The nonrefundable $150 Application Fee is due once per year. PaYment of fees N  ew ALC Students: We will reserve a space in your first program when you pay the $150 application fee. The Student Services Fee and Program Fee are due by the payment deadline of your first program (see page 3). If you would like to enroll in multiple programs, you must pay the Student Services Fees and Program Feeswe cannot hold your space for additional programs without payment.  Continuing ALC Students or Students Transferring from Another School: You must pay all fees (the Student Services Fee and Program Fee) in order to reserve your space in each program. Programs may fill up before the payment deadline, and we cannot reserve a space without full payment. Selecting programs on the application without paying does not mean that you are enrolled. Academic Intensive English Program (AIEP):
Quarter Winter 2014 Spring 2014 Summer 2014 A Summer 2014 B Summer 2014 C Fall 2014 Program Dates Jan 6-Mar 14 Mar 31-Jun 6 Jun 23-Sep 12 Jun 23-Aug 1 Aug 4-Sep 12 Sep 29-Dec 5 Program Length 10 weeks 10 weeks 12 weeks 6 weeks 6 weeks 10 weeks Application Fee u $150 u $150 u $150 u $150 u $150 u $150 Project ID 242-407 242-409 242-41 1 242-413 242-415 242-417 Student Services Fee u $870 u $870 u $1,005 u $610 u $610 u $870 Project ID 242-408 242-410 242-412 242-414 242-416 242-418 Program Fee Project ID u $4,415 241-973 u $4,415 241-974 u $4,675 241-975 u $2,370 241-976 u $2,370 241-977 u $4,415 241-978

Intensive English Communication Program (IECP):

Quarter Winter 2014 12 Winter 2014 A Winter 2014 B Winter 2014 C Spring 2014 12 Spring 2014 A Spring 2014 B Spring 2014 C Summer 2014 A Summer 2014 B Summer 2014 C Fall 2014 12 Fall 2014 A Fall 2014 B Fall 2014 C Program Dates Jan 6-Mar 27 Jan 6-30 Feb 3-27 Mar 3-27 Mar 31-Jun 19 Mar 31-Apr 24 Apr 28-May 22 May 27-Jun 19 Jun 30-Jul 24 Jul 28-Aug 21 Aug 25-Sep 12 Sep 29-Dec 18 Sep 29-Oct 23 Oct 27-Nov 20 Nov 24-Dec 18 Program Length 12 weeks 4 weeks 4 weeks 4 weeks 12 weeks 4 weeks 4 weeks 4 weeks 4 weeks 4 weeks 3 weeks 12 weeks 4 weeks 4 weeks 4 weeks Application Fee Project ID Student Services Fee Project ID Program Fee Project ID u $150 242-419 u $1,055 242-420 u $5,425 241-979 u $150 242-421 u $475 242-422 u $1,875 241-983 u $150 242-423 u $475 242-424 u $1,875 241-984 u $150 242-425 u $475 242-426 u $1,875 241-985 u $150 242-427 u $1,055 242-428 u $5,425 241-996 u $150 242-429 u $475 242-430 u $1,875 241-986 u $150 242-431 u $475 242-432 u $1,875 241-987 u $150 242-433 u $475 242-434 u $1,875 241-988 u $150 242-435 u $475 242-436 u $1,875 241-989 u $150 242-437 u $475 242-438 u $1,875 241-990 u $150 242-439 u $410 242-440 u $1,460 241-991 u $150 242-441 u $1,055 242-442 u $5,425 241-992 u $150 242-443 u $475 242-444 u $1,875 241-993 u $150 242-445 u $475 242-446 u $1,875 241-994 u $150 242-447 u $475 242-448 u $1,875 241-995 5

3. Student Details
Name as shown on passport (Family Name, First Name, Middle Name)

Is this your first time studying at the ALC? u Yes u No Are you transferring to the ALC from another school in the U.S.? u Yes u No If yes, name of the school:_______________________________________________ Will you need special services to accommodate a physical, perceptual, or learning disability? u Yes u No If yes, please explain (attach separate page if you need more room): ____________________________________________________________________

Student Email Address:_________________________________________________ Country of Birth:_______________________________________________________ Country of Citizenship:__________________________________________________

Students Permanent Home Country Address (required)cannot be a post office box: Street:_______________________________________________________________ City: _____________________________________________ Country: _______________________________ State:____________

Emergency Contact Information (in the U.S. or in your home country) Home Country Contact Persons Name:____________________________________ Relationship: __________________________ Tel: __________________________
(father, mother, friend, etc.)

Postal Code: _ _______________

Email: _______________________________________________________________ Local Contact Persons Name: ___________________________________________ Relationship: _________________________ Tel: ___________________________
(father, mother, friend, etc.)

Tel: _______________________________ Fax: ____________________________ Mailing Address *If you are a transfer student, you must include an address in Los Angeles below. u Check this box if your mailing address is the same as your permanent address. Street: ______________________________________________________________ City: _____________________________________________ State: ___________ Country:__________________________________ Postal Code: _ ______________ Tel: _______________________________ Fax:_____________________________

Email: _______________________________________________________________ This person is allowed to discuss my application with the American Language Center: Name:_______________________________________________________________ Email: _______________________________________________________________

4. Financial Certification
You and/or your sponsor are financially responsible for your educational and living expenses for the duration of your educational program as well as for the educational and/or living expenses of your husband, wife, and/or children who will accompany you. Additionally, UCLA Extension may share information from your academic record with your financial sponsor. Calculation of Financial Support You may use the following table to calculate your educational and living expenses before you complete sections A and B at the right. Minimum Funds Required for Program Duration of Stay 3 or 4 weeks 6 weeks 10 weeks 12 weeks Students Education & Living Expenses $4,188 $5,662 $9,655 $1 1,694 + Spouse $584 $876 $1,460 $1,752 + Each Child $384 $576 $960 $1,152 $ $ $ $ Total

A. Sponsor Statement (must be in English) I have read the information regarding the cost of the program and living expenses for the period of study at UCLA Extension American Language Center. I certify that these funds are available for the student and accompanying family members. I accept full responsibility for these expenses and have included fund verification from my bank. This section must be signed only by the bank account holder. Name:_________________________________ Relationship:_ ________________
(self, father, mother, friend, etc.)

Street:_______________________________________________________________ City:______________________________________ State:______________________ Country:_ __________________________________ Postal Code:_ _______________ Signature:_________________________________ Date:_ _____________________ uC  heck here if you are submitting a separate letter of sponsorship, signed and dated within the last 60 days, which states the amount of financial support and the relationship to the student, instead of completing A above. B. Verification of Bank Funds (must be in English) This is to certify that the applicant or sponsor listed above is financially capable of meeting the minimum funds required for the program, which includes funds for husband, wife, and/or children. If the funds are outside the United States, the applicant is permitted to use them under his/her governments present regulations. Name of Bank Official: _ ________________________________________________ Title of Bank Official:_____________________________ Bank Officials Signature _________________________ Date (within the last 90 days)______________________ Bank Stamp or Seal (This is not a guarantee of funds.)

Will a husband, wife, and/or children accompany you with a F-2 visa? u Yes u No If yes, please list:

1. Name:_____________________________________________________________
(Family Name, First Name as shown on your passport)

Country of Birth:_________________________ Date of Birth:_______________ Country of Citizenship: ____________________ Relationship:________________ 2. Name:_ ____________________________________________________________
(Family Name, First Name as shown on your passport)

Country of Birth:_________________________ Date of Birth:_______________ Country of Citizenship: ____________________ Relationship:________________ Include a copy of each dependents passport page showing the photo identification and attach an extra sheet for additional dependents.

uC  heck here if you are including an original bank letter written on official bank stationery (dated within the last 60 days) instead of completing B above.

5. Student Terms of Agreement:

u I agree that all information is accurate and that I have read and agree to accept the UCLA Extension American Language Center refund policy. Name: _______________________________________________________Date (month/day/year): _______________________ 6

2014 American Language Center Cancellation, Refund, and Transfer Policy

All cancellation, refund, and transfer requests must be submitted on an ALC Cancellation, Refund, and Transfer Request Form and are subject to approval by American Language Center (ALC) management. If payment was made by credit card, in most instances, a credit will appear on the same credit card used (allow 3-5 weeks for processing). If payment was made by check, cash, or bank wire transfer, a refund check will be issued (allow 6-8 weeks for processing). There is a $30 processing fee for each refund issued, and this fee is subject to change. A. Nonrefundable Application Fee All application fees must be paid before submitting the application. The American Language Centers (ALC) program application and housing application fees are non-refundable. B. Cancelling Programs Prior to Arrival in the U.S. Students who cancel prior to arrival in the U.S. must submit a Cancellation, Refund, and Transfer Request Form prior to the start date of their program to receive a refund. Students who have been denied a student (F-1) visa must submit a Cancellation, Refund, and Transfer Request Form by Friday of the first week of the program. A visa denial letter in English is required if a refund is requested due to a visa denial and if the request is submitted after the program start date. If we receive a request after the deadlines above, the student will not receive a refund. C. Deferring Programs Prior to Arrival in the U.S. In order to defer programs, students must submit a Cancellation, Refund, and Transfer Request Form on or before the Friday of the first week of the program. A new application also must be submitted at this time with a new program start date. If all required documents are submitted, ALC can transfer the original payment to an available future program. A $125 program transfer fee will be collected if a deferral request is received after the program start date. D. Cancelling Programs after Arrival in the U.S. No refund will be granted if students enter the U.S. with government documents indicating that they plan to study at UCLA Extensions American Language Center and if they do not enter a UCLA Extension program. Continuing students who wish to cancel subsequent programs must submit a completed Cancellation, Refund, and Transfer Request Form prior to the program start date. If we receive a request after the deadlines above, the student will not receive a refund. Under special circumstances, students may receive an eighty percent (80%) refund if the Cancellation, Refund, and Transfer Request Form is received by the Friday of the first week of their ALC program and is approved by the Program Manager. No refunds will be approved after the Friday of the first week of the program. If a students I-20 expires through no fault of UCLA Extension-ALC, a refund will not be issued. If students arrive after the Friday of the first week of the program, they will not be able to attend and will not receive a refund. E. Transferring from One ALC Program to Another ALC Program All transfers between ALC programs within the same quarter must be requested using the Cancellation, Refund, and Transfer Request Form and approved by the Program Manager or Academic Advisor. There will be a transfer fee of $125. The transfer fee is due at the time of the new enrollment. A new ALC enrollment application must be completed, and payment for the new program must be submitted. No transfer requests will be approved after the first Friday of the program. F. Transferring to Another School If you plan to transfer to another school after attending ALC programs, please contact the UCLA Extension International Student Office: iso@uclaextension.edu. If you plan to transfer to another school instead of attending an ALC program, you will need to fill out a Cancellation, Refund, and Deferral Request Form and refer to section D above regarding the refund. Then contact the International Student Office regarding transferring to another school. * You can find the Cancellation, Transfer, and Refund Request Form on our website at uclaextension.edu/alc, or you can request a form by emailing alcenroll@uclaextension.edu or by calling (310) 825-9068.

2014 American Language Center Cancellation, Refund, and Transfer Request Form
Please print clearly: Student Name:____________________________________________________________________________________________________
Family Name First Name Middle Initial

Date of Birth (month/day/year):_______________________________ Student ID Number: ____________________________________ If applicable, agency name: __________________________________________________________________________________________ Address to send refund:_____________________________________________________________________________________________ Email Address: _____________________________________________ Phone Number:_____________________________________________ Current Program: u AIEP (Academic Intensive English Program) u IECP (Intensive English Communication Program) u ACC Course (American Culture and Communication Coursemornings only)

I am requesting a: u cancellation from the following program: u AIEP start date:_________________ u IECP start date:_________________ u ACC Course start date:_________________ u transfer to the following program (a new application form is required): u AIEP start date:_________________ u IECP start date:_________________ u ACC Course start date:_________________ Reason for request: ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ I have read and understand the ALC Cancellation, Refund, and Transfer policy (see page 7): Student Signature:___________________________________________ Date (month/day/year):________________________________

For administrative use only: Refund: u F prog & ss u 80% prog & ss u Transfer Fee u Other____________________________

u Approved by 1)____________________________________ 2)____________________________________ u Denied___________________________________________ Date (month/day/year):__________________