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Intensive English Program Application Form (Please complete the I-20 Application  [if applicable] )

Please print, complete and mail this form to: Director, English Language Institute C.W. Post Campus, Long Island University 720 Northern Blvd. Brookville, NY 11548, USA

Date: ___________________________________________________ Name:_______________________________________________________ Address: __________________________________________________ __________________________________________________________ __________________________________________________________ City: _________________________________________________ State:______________  Zip:_________________________________ Country: __________________________________________________ Telephone: ___________________________________   Date of Birth: _______/_______/_______   Place of Birth: ________________          Email:________________________________________ Country of Citizenship: __________________________________________ Please indicate Spring 2009 ___ Summer 2009___ Fall 2009 ___ Category:    Are you applying for C.W. Post graduate study ? _________________  If so, program ___________________________________ Are you applying for C.W. Post undergraduate study? _________________       If so, major program if known ______________________ Are you interested in applying to  C.W. Post? _________________ English Language Institute only ? _________________ TOEFL or IELTS SCORE, if known______________________________________________________________ Will you require lodging?  ______________yes  _______________no  Have you ever studied English in a special English class outside of your high school or college?  _____________ yes ______________no Please indicate your present knowledge of English by circling the response Understanding good fair poor none Speaking good fair poor none Reading good fair poor none Writing good fair poor none Record of your education (High School, College, University Name of School Location Dates Diploma                                           COMMENTS/ QUESTIONS:_________________________________________________________________ _____________________________________________________________________________________