International Application Form

DB No:
Student Relations:
Accredited Member, ACICS | IBHE PBVS Approved
International Application 2015 - 2016
o Change of Status o Transfer o From Abroad o Other
o F1 o J-1 o B1/B2 o M1 o H1B o F2 o M2 o Visa Waiver o Out of Status o Other:_____________________
Application Type:
Status:
Today’s Date: _____ /_____ /________
Month
Day
Year
First Name: ___________________________ Middle Name: ____________________________ Last Name: ________________________________
Gender:
oM oF
Date of Birth: ____ /____ /________ Primary Phone: (___________)____________________________________________
Month
Day
Year
Secondary Phone: (___________)_____________________________ Email: __________________________________________________________
Contact Person in the U.S.A. _________________________________ Contact Person’s Phone Number: (_____)____________________________
Home Country Address: ___________________________________________________________________________________________________
SECTION 1
Number & Street
Apt.#
City: ___________________________ Province: __________________________ Zip/Postal Code: _________ Country:__________________
Address in the U.S.A. ______________________________________________________________________________________________________
Number & Street
Apt.#
City: ______________________________________________ State: _________________________ Zip/Postal Code: _____________________
Passport Information:
City of Birth: ________________________________ Country of Birth: __________________________ Citizenship: ________________________
Passport Number: _______________________________________________________________________ Expiration Date: ____ /____ /________
Month
Day
Year
Visa Information (if already in the U.S.A.): __________________________________________________________________________________________________
I-94 Number: _______________________________________________ Entry Date: ____ /____ /________ Expiration Date: ____ /____ /________
Month
Day
Year
Month
Day
Year
How did you hear about BIR?
o Internet Advertising o Internet Search Engine o Social Media - o Facebook o Twitter o YouTube o Other:_____________________
o Newspaper/Magazine o Radio o TV o Flyer/Brochure o Friend/Relative o Current/Former Student
o Other Please be specific: ________________________________________________________________________________________________
SECTION 2
I am Interested in:
o Full-time General English o Accelerated English o IELTS/TOEFL-iBT/University preparation
o English for Specific Purposes (Business, Computer, Hospitality & Tourism, Journalism, Medical, Test Preparation)
o Business Communication o Private Tutoring
o Recreational Part-time English, suitable for applicants on visa waiver F2, B-1/B-2, and some others.
Mark the statements that accurately reflect your objectives at BIR:
o Learn/Improve English o Prepare for College/University o Earn English for Specific Purpose Certificate
more
more
Phone: (773) 866-0111 | Fax: (773) 866-0113 | www.birtraining.edu
05.12.15_INTRNLAPP
3601 W. Devon Ave. Chicago, IL 60659 | 828 S. Wabash Ave. Chicago, IL 60605 | 6240 W. Belmont Ave. Chicago, IL 60634 | 5440 N. Cumberland Ave.Chicago, IL 60656 | 5338 N. Northwest Hwy. Chicago, IL 60630
DB No:
SECTION 2 (cont.)
I Plan to Start In:
o June 2015
o January 2016
o July 2015
o August 2015
o September 2015
o October 2015
o November 2015
o March 2016
o April 2016
o May 2016
o June 2016
Preferred Schedule: o Morning o Afternoon o Evening o All Day o Weekdays o Weekend o Any Available
Preferred Location: o Devon o Loop o Belmont o O’Hare
Do you need housing in Chicago? o No
o Yes, I prefer: o Homestay o Hostel o Private Apartment
Will you bring family members? o No o Yes If yes, when: ____ /____ /________ and how many: __________
Do you need medical insurance?
o No o Yes
Do you have any medical conditions, physical disabilities, mental health issues?
o No o Yes, If yes, please describe: ____________
Month
Day
Year
_________________________________________________________________________________________________________________________
As an international student, I acknowledge that
I have made financial provisions to meet education and living expenses for myself and an accompanying family member(s) for an academic year which
is 40 weeks and includes at least 5 courses. The 2015-2016 academic year living expenses are $8,757 for the student and $3,400 per family member.
The school also offers an extended academic year, 48 weeks - 6 courses, and accelerated shorter courses. For a longer and shorter study, the amount is
prorated accordingly.
I grant BIR Training Center permission to photograph, record, and tape me while attending BIR Training Center or activities conducted by BIR Training
Center. I understand that BIR Training Center will own the photographs and/or video footage in which I appear, and have the unrestricted right to publish
such photographs and use such video in any BIR Training Center sales literature, on the BIR Training Center website, and in any other BIR Training Center
material. I grant permission for BIR Training Center to send me email offers, newsletters, and updates unless I provide a separated written notice to optout.
I acknowledge that no federal or state financial aid is available for me and that on-campus employment is not guaranteed by the school.
I have disclosed any disabilities during the application process in order for BIR Training Center to assess whether they can be reasonably accommodated.
I certify by my signature that statements made herein are complete and accurate to the best of my knowledge. If admitted to BIR Training Center, I agree
to comply with its rules and regulations, and to pay tuition and fees in accordance with the enrollment agreement.
Applicant’s Signature ____________________________________________________________ Date: ____________________________
Additional Comments: ______________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Note: International applicants must demonstrate financial ability:
If you are paying for your own education, you must attach a letter or statement from a bank or a financial institution with your name on it.
If you are using a private sponsor for financial support, your sponsor must complete a Statement of Financial Support (U.S. Dept. of Justice Form I-134), and submit
a letter or statement from his/her/their bank along with supporting documents. If you are using institutional or government support, your sponsor must submit a
letter or statement from a bank and a letter of support stating the amount available for your education and living expenses, and naming BIR Training Center as the recipient.
If you are accepted, other supporting documentation may be required.
Phone: (773) 866-0111 | Fax: (773) 866-0113 | www.birtraining.edu
05.12.15_INTRNLAPP
3601 W. Devon Ave. Chicago, IL 60659 | 828 S. Wabash Ave. Chicago, IL 60605 | 6240 W. Belmont Ave. Chicago, IL 60634 | 5440 N. Cumberland Ave.Chicago, IL 60656 | 5338 N. Northwest Hwy. Chicago, IL 60630