Universities in the USA 2010

universitiesintheusa.com

Application for enrollment

First read the instructions on page 3. You can enter most details by computer (click ‘Highlight Fields’ at the top of the screen) but signatures must be
hand-written. When the form is complete, use the ‘Print form’ button at the end of page 3. Alternatively, print the blank application form and complete it
by pen (write in capital letters) or typewriter. Return your application and supporting documents to the contact details at the end of page 2.
Check boxes where appropriate.
University/College preference
For course availability see our website at universitiesintheusa.com

In the 3 lines below, indicate your preference by listing university name and location:
1st choice:
2nd choice:
3rd choice:
Academic year beginning  Fall 20  Spring 20
Type of program you are applying for  Undergraduate degree  Master’s degree
Do you require English language instruction?  Yes, I do  No, I don’t  Don’t know
Do you currently hold a valid I-20 from another US school?  Yes, I do  No, I don’t
Preferred major/course of study
Check if you are enrolling in the Student Advising and Support Service  (Additional fee)
Student details
Family name Home address
Given name(s) City / Postal code
Date of birth (mm/dd/year) / / Country
Age Home telephone
Sex  Male  Female Mobile
Nationality Fax
Passport number Expiration date Email

Parent/Guardian  Check this box if you would like to receive periodic special offers and news from Study Group
You can unsubscribe at any time, and your email address remains confidential.

Name Home address

Relationship to student City / Postal code
Email Country
Mobile Home telephone
Business telephone Fax

Agreement - by the parent, legal guardian or sponsor

I apply to enroll the person named as a student of Study Group. I agree to pay all tuition and accommodation fees incurred by the student as they become due in accordance with the Terms & Conditions and
either to give the required notice of cancellation or to pay the required fees in lieu of notice. I give permission for the administration of first aid and appropriate non-prescription medication to my child, and
give permission to Study Group/Universities in the USA and designated college representatives to seek medical, dental or optical treatment when required. I am the parent or legal guardian named.

Full name
Signature Date

Emergency contact
Full name Relationship
Phone Address

Criminal and disciplinary record

Other than traffic violations, have you ever been convicted of a misdemeanor, felony or other crime?  Yes  No
Have you ever been charged, suspended, removed, dismissed or expelled from any educational
 Yes  No
institution for academic or disciplinary reasons?
If you answered yes to either question above, please submit a full statement of relevant facts (including the approximate date of the incident) on a separate sheet of paper.

Financial information and sponsor waiver

What is the maximum amount of funds that will be available to you, per year, for your studies and all living expenses?
Amount in $ U.S.
Person or organization responsible for your financial support
Address of sponsor

I do certify that I will provide the student named above with

 $ U.S. yearly for his/her study at a U.S. institution. This amount does not include round-trip air fare.

signature of sponsor Date

signature of student Date

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 Applicant’s full name

Educational History
List the names and dates of each school you attended, beginning with high school and including College/University if any.
Undergraduate applicants - Please send Secondary School Transcript for final 3 years.
Date from: Date to: Name of school Location
Date from: Date to: Name of school Location
Date from: Date to: Name of school Location
Date from: Date to: Name of school Location

Name of Secondary Graduation Certificate

Date of graduation if applicable (Month/Year)

Graduate School applicants - Please indicate Post-Secondary or University Education.

Date from: Date to: Name of school Location
Date from: Date to: Name of school Location

Name of degree received

Date (Month/Year)

Standardized testing (optional)

Please enclose copies of your test score reports.

TOEFL Date taken: Score

GRE Date taken: Score
GMAT Date taken: Score
OTHER Date taken: Score

Transcript of grades
See instructions on next page regarding submission of academic transcripts. Below, please enter an explanation of the grading system and scholastic evaluation:

A+ = A to A- = B+ to B = B- to C = C- to D =
Date student will graduate
Student’s current or most recent Grade Point Average

Language teacher’s recommendation (optional)

Please see additional information on the next page.
Name
How long have you known the applicant? How long have they been your student?
In what language have you taught the student?

In the section below, please indicate the student’s English language background and proficiency by checking the appropriate box:
Language Proficiency  Excellent  Good  Average  Fair  Poor
Reading  Excellent  Good  Average  Fair  Poor
Writing  Excellent  Good  Average  Fair  Poor
Speaking  Excellent  Good  Average  Fair  Poor
Understanding conversation  Excellent  Good  Average  Fair  Poor
In the section below, please indicate the student’s character by checking the appropriate box:
Maturity  Excellent  Good  Fair  Poor
Responsibility to self  Excellent  Good  Fair  Poor
Responsibility to others  Excellent  Good  Fair  Poor
Honesty  Excellent  Good  Fair  Poor
Openness  Excellent  Good  Fair  Poor
Sense of humor  Excellent  Good  Fair  Poor
Creativity  Excellent  Good  Fair  Poor
Personal motivation  Excellent  Good  Fair  Poor
Academic motivation  Excellent  Good  Fair  Poor
Ability to adapt to new experiences  Excellent  Good  Fair  Poor
Ability to interact with others  Excellent  Good  Fair  Poor
Overall character  Excellent  Good  Fair  Poor
Check that you have
 completed the form in full and checked for accuracy  enclosed full transcript of all your relevant qualifications, translated into English
 written and attached your student letter  enclosed your bank statement (in original language and English)
 attached a photocopy of your passport identification page  read, understood and signed the Terms and Conditions on page 3

Please submit your application by mail or fax, or email a scanned copy to: uiusa@studygroup.com
Fax: +1 415 373 9374 – Tel: +1 415 345 2955 – Address: Universities in the USA, Central Admissions, 1462 Pine Street, San Francisco, CA 94109, USA

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Terms & Conditions
Students must read these Terms and Conditions carefully and
understand them before signing and submitting their application
for Universities in the USA. ESL Transition Programs are
administered and taught by Study Group USA.
Participant responsibility
The price for the Study Group/Universities in the USA program
does not include the following expenses:
1) Personal spending money.
2) Insurance for pre-existing medical conditions, i.e., ailments
which exist prior to arrival in the U.S.
3) Meal and housing costs during the few times the university is
officially closed – usually limited to the Thanksgiving holiday in
late November, the Christmas holiday (which normally lasts about
four weeks) and Spring vacation (approximately 10 days).
4) University textbooks and other necessary school supplies.
5) Air fare to and from U.S. domestic airport closest to the university
campus in the United States (a round trip ticket is required).
6) Extra costs for ESL which may be required by a student whose
English language proficiency is inadequate.
7) Graduate students are invoiced for tuition only, unless the
invoice specifically states that room and board is included. Any
room or board charges accrued by graduate students will be paid
by the student directly to the university.
Special cases
Students with special needs or requirements should make these
known at the time of application. The program may be able to
accommodate such variations from the normal profile.
Rules
All participants in the Study Group/Universities in the USA
program are subject to the rules of the university in which they are
enrolled. Students must assume full responsibility for compliance.
Rules governing alcohol, controlled drugs, honors offenses, and
other serious matters will be strictly enforced. Applicants are
reminded that international students in the United States must
comply with both the letter and the spirit of the law in order to
retain valid student visas. Violations of such laws will render the
participant liable for immediate dismissal from the program and
repatriation to the home country, if not legal prosecution for
violation of the laws of the state or federal jurisdictions involved.
No refund of fees will be made in the event of dismissal or
withdrawal.
Payment of fees
Fees for the Study Group/Universities in the USA program will be
paid as follows:
• Following University acceptance, a $500 deposit will be
required to release the I-20 immigration document. This deposit is
refundable in the event of a visa denial.
• Program/tuition fees are payable upon notification of
acceptance.
• Undergraduate (Bachelor’s) students can choose to pay either
a) in full in advance, or b) in two payments – the first installment of
60% of tuition/room/board fees is due one month before the start
of the first semester, and the second installment of 40% of tuition/
room/board fees is due one month before the start of the second
semester. An additional $500 service fee is incurred for the two-
part payment option.
• Graduate (Master’s) students may pay 50% of tuition fees one
month before the start of the first semester, and the remaining
50% one month before the start of the second semester. There is
no service fee for graduate program payments..
• Delayed payments incur a $100 late fee.
• American Express, Mastercard, and Visa credit card payments
accepted. A processing fee will be applied.
Applying for a visa
Once a student has been accepted, they will be provided with an
I-20 Form from the U.S. Immigration and Naturalization Service,
issued by the participating university. This form will be sent upon
receipt of the $500 deposit. An I-20 Form is required to start the
process of obtaining a student visa to enter the United States. You
will also be required to present financial documentation to the U.S.
Consular Office in your country. We advise you to have a letter from
your parents or other source of support stating their responsibility
for your expenses throughout. A bank statement or letter verifying
their financial ability to cover your expenses should also be provided.
Applicant printed name
Applicant signature
Date
Parent/Guardian printed name
Parent/Guardian signature
Date
Late applications
Admission is subject to space availability so early application and
payment is advised. In particular, students are advised to apply for
a visa as soon as possible, because the process can cause delays to
admission.
Cancellations and refunds
Cancellations received prior to July 1 for fall applicants or prior to
November 1 for spring applicants will receive a full refund less a
service fee of $500. After these dates, but before the academic year
begins, the application deposit and one-half of the year’s tuition/
fees will be non-refundable. If possible, we strongly recommend a
student defer to the following semester rather than cancel.
Students who defer or withdraw on or after the academic year
begins will not be eligible for a refund. If the student does not
receive an acceptance or is unable to obtain a visa, a full refund,
including the $500 deposit, will be issued.
Length of enrollment
1) First year undergraduate students must enroll for an entire
academic year (2 semesters) and will be required to live on the
university campus.
2) Returning undergraduate students must enroll for an entire
academic year and may live off campus if university policy permits.
Furthermore, no refunds will be given for cancellations requested
after classes begin.
3) Graduate students must enroll in their complete academic
program.
Medical release authorization
We, as parents/guardians of undersigned student, do hereby
authorize Study Group/Universities in the USA and its assigned
agents, and any designated program representative, as agents of
the undersigned parents, to consent to any X-ray examinations,
anesthetic, medical or surgical diagnosis or treatment, or hospital
care which is deemed advisable by, and is rendered under, the
general supervision of any licensed physician or surgeon, whether
such treatment or diagnosis is rendered at the office of said
physician or surgeon or at a hospital. It is understood that this
authorization is not given in advance of any specific diagnosis,
treatment or hospital care being required, but is given to provide
authority and power on the part of aforesaid agents to give
specific consent to any and all such diagnoses, treatments, or
hospital care which the aforementioned physician or surgeon, in
the exercise of her/his best judgement, may deem advisable.
Agreement and release
We, the undersigned, do waive and release all claims against Study
Group/Universities in the USA and its agents for any injury, loss,
damage, accident, delay, or expense resulting from the applicant’s
participation in the Program. We also release Study Group/
Universities in the USA and its agents and agree to indemnify
them with regard to any financial obligations or liabilities that the
applicant may personally incur or any damage or injury to the
person or property of others that the applicant may cause while
participating in this program. We understand that the program
begins with the outbound flight to the United States and
terminates when the return flight lands. We realize that any
airline’s liability for loss or damage to baggage or property, or for
death or injury, is limited by the terms outlined by these airlines.
We also understand that it is our responsibility to obtain a
passport or any required visa. We understand that Study Group/
Universities in the USA is not responsible for any loss or injury
suffered by the applicant during periods of independent travel or
absence from the Program. If the applicant becomes ill or
incapacitated, Study Group/Universities in the USA or its agents
may take such actions as it considers necessary, including securing
medical treatment and transporting the applicant home at her/
his own expense. We release Study Group/Universities in the USA
from all liability related to such actions. We understand that the
applicant’s participation in the Program may be terminated at the
discretion of Study Group/Universities in the USA without any
refund of fees, and that the applicant may be sent home at her or
his own expense if she or he does not adhere to U.S., State, and
local laws, and university rules. We agree to accept full
responsibility for personal expenses, books, any required additional
language training, and round trip air fare. In the event that Study
Group/Universities in the USA or its agents advance or loan any
monies to the applicant or incur special expenses on her or his
behalf, we agree to make immediate repayment to Study Group/
Universities in the USA. We understand that this agreement with
Study Group cannot be modified or interpreted except in writing
by Study Group/Universities in the USA.
We also understand that cancellations received prior to July 1 for
entry beginning in the fall or prior to November 1 for entry
beginning in the spring will receive a full refund less a service fee
of $500. After these dates, but before the university entry date, the
application deposit and one-half of the year’s fees will be
nonrefundable. Students who defer or withdraw on or after the
university entry date will not be eligible for a refund.
Application instructions
1. This application form must be completed in English in pen
(using capital letters), or by computer or typewriter. The Student
Letter must be hand-written.
2. State your name on page 1 as it appears on your passport. Also
ensure that your name appears on each page.
3. On each page that requests a signature, the original signature
of the appropriate person (teacher, parent, etc.) must be provided.
4. The following items must accompany the application:
• An official copy of final transcript (in original language and
English) showing entire secondary school record, and
undergraduate record if applicable (see details below).
• Bank statement (in original language and English) indicating
adequate funds to support at least one full year of academic study
as well as personal expenses.
• A photocopy of your passport identification page.
• A photocopy of your current I-20, if applicable.
• Student letter (see details below).
• Graduate Program applicants submit two letters of
recommendation and personal statement.
Transcript of grades
1. Undergraduate applicants must submit official copies of their
transcripts showing the final three years of secondary education.
• A school’s seal or principal’s signature must appear on the copy.
• If necessary, the transcript must be translated into English. If
translation is required, the translation must be authorized as a
true copy by a notary public or similar official.
• Originals will be required upon registration at the university.
2. Graduate School applicants submit official attested copy of
entire undergraduate transcript (in original language and English).
3. Transfer applicants send an official undergraduate record.
• If transferring after one year of university, submit secondary
school transcript in addition to first year university transcript.
• If transferring after second or third year, submit university
transcript only.
• If student is seeking transfer credits, catalog course descriptions
are required and must accompany the application.
Language teacher’s recommendation (optional)
Regardless of the level of English language proficiency, there will
be periods of difficulty and frustration for any student who will be
functioning for the first time in a foreign language, especially
during a long-term stay at a university abroad. On a separate page,
please comment on the applicant’s character, aptitude, motivation,
study habits and attendance record.
Your comments will be extremely helpful in predicting the
applicant’s success in their Study Group/Universities in the USA
program.
Student letter
Attach a letter of at least 300 words that will introduce you to your
new university community. This should be your own work, but you
may write several drafts and use a dictionary. Check your work
carefully before submitting the final letter. The university is
interested in knowing as much as possible about you. The
following are some suggested topics from which to choose. Please
feel free to include anything else that you believe would support
your candidacy.
• Describe the most memorable event in your life (positive or
negative), and how it changed you.
• Describe your activities and responsibilities at home, school, or
in your community.
• Describe your future job or career plans. (Graduate school
applicants write on this topic only).
• Explain why you want to take part in this program and why you
want to attend a university in the USA.
9512U 1/10
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