Online ESL Program Application General Application Semester Select a semester Spring 2013 Summer 2013 Fall 2013 Spring 2014 Summer 2014 Fall 2014 Spring 2015 Summer 2015 Fall 2015 How did you discover the Duquesne ESL Program: Friend/relative My government Advertisement Other: Applicant First Name Family Name Email Address Date of Birth [dd/mm/yyyy] Country of Birth Country of Citizenship First Language Sex: Male Female Marital Status: Single Married Permanent Foreign Address City State/Province Postal Code Country Telephone number Facsimile number (fax) optional Visa Status IMPORTANT: If you are currently in the United States, please indicate your visa status F-1 F-2 J-1 J-2 Other: You will be required to submit a copy of your current I-20 form (F visa students) or IAP-66 form (J visa students) to assist in the processing of your application for transfer to Duquesne University. Housing Are you planning to live On campus Off campus Will anyone accompany you? Yes No If yes, please list their name(s), followed by date of birth and relationship: Note: Housing for families of accepted students is only available off campus. Education Please list the names of secondary schools, universities, or English language programs which you attended in your country and the United States: Secondary School University Language Program Financial Declaration International applicants must submit either official bank statements with a bank official's signature/seal or an official copy of a sponsoring agency's guarantee (for agency-sponsored students) certifying minimum availability per semester of study. Specific source of funds (complete Part A or Part B): Part A: Personal Family Private Sponsor Name of Sponsor: You will be required to submit an official bank verification letter, in English, stating that sufficient funds are available to support your stay in the United States. Part B: Government Agency Sponsoring Agency Agency Name: You will be required to submit an original scholarship letter, in English, stating that the scholarship agency will pay your expenses to study in the United States. Electronic Signature By entering your name below and submitting this document, you certify that all statements made on this form are complete and accurate. Full Legal Name Comments / Questions
