Application - University of Illinois at Chicago

Application
Tutorium in Intensive English
1333 South Halsted Street, Suite 260, Chicago, Illinois 60607-5019, U.S.A.
Telephone: (312) 996-8098 Fax: (312) 996-4394
Email: tutorium@uic.edu Website: www.uic.edu/depts/tie
PERSONAL INFORMATION:
Name: Last/Family name First/Given name Middle
Sex: Female Male Birthdate: month/day/year
/ /
Country of birth Country of citizenship Native language
To ensure the correct spelling of your name on the I-20 form, please include a copy of your passport identification page with this application.
Current address City State/Province
Postal Code Country Telephone: Day Evening Email
FIRST SESSION YOU WANT TO ATTEND: (Choose one)
U.S. Immigration policy requires all applicants for F-1 visas to be full-time students.
Fall (Monday – Thursday)
Schedule (Choose one)
Full-time
Part-time Reading/Writing afternoon
Part-time Listening/Speaking evening
Spring (Monday – Thursday)
Schedule (Choose one)
Full-time
Part-time Reading/Writing afternoon
Part-time Listening/Speaking evening
Summer (Monday – Friday)
Schedule (Choose one)
Full-time
Part-time Reading/Writing morning
Part-time Listening/Speaking afternoon
Campus housing is available to Tutorium students.
Would you like an application for on-campus housing? Yes No
Highest level of education you completed: High school College/University
If you are in the U.S. now, your immigration status is (visa type):
F-1 Resident/Citizen Other:
Date of arrival in the U.S.: month/day/year / / I-94 card expiration date: month/day/year / / or, D/S
Studying in the U.S. now: No Yes, Name of school:
Applied to or attended the Tutorium in the past: No Yes, Session: Year:
LOCAL CONTACT IN U.S.:
Name: Last/Family name
First/Given name
Current address City State
Postal Code Telephone: Day Evening Email
This application is valid only if it has been signed by the applicant.
This application form can be filled
out online and printed from our
website www.uic.edu/depts/tie
Signature: ______________________________________________ Date:_____________

Application continued
Tutorium in Intensive English
I-20 APPLICATION INSTRUCTIONS:
(for F-1 student visa)
To obtain an I-20 form you need to submit the following documents:
• Complete application
• Application fee
• Proof of Financial Support
PROOF OF FINANCIAL SUPPORT:
Indicate the source of support and follow the instructions.
Student funds One original bank letter on bank letterhead.
This letter must be no older than 6 months and the amount
available must be no less than the ESTIMATED EXPENSES
PER SESSION.
This letter can show the amount in U.S. dollars or the
equivalent of this amount in any other currency. If the letter is
not in English, a translation must be attached.
You will need a second bank letter to submit to the U.S.
Embassy or Consulate when you apply for the F-1 student visa.
Sponsor funds In addition to the bank letter from your
sponsor, you must also submit a signed affidavit of support.
Scholarship or other institutional support Submit an official
letter from the sponsoring organization that states the specific
amount of funds granted.
If you are applying from overseas, please check with the U.S.
consulate in your country for processing times and procedures, and
begin the process as soon as possible.
If you are transferring to the Tutorium from another school,
submit the Transfer Verification Form available in the Tutorium Office
or on-line at www.uic.edu/depts/tie.
AFFIDAVIT OF SUPPORT:
Name of sponsor (source of support while in the U.S.)
Current address
City State/Province Postal Code
Country Telephone: Day Evening
Relationship to student:
I do hereby declare that I am willing and able to financially
maintain and support:
Name of student:
During his/her period of study at the Tutorium in Intensive English
at the University of Illinois at Chicago.
___________________________________________________
Signature of sponsor:
PLEASE SEND I-20 TO:
Student’s current address
Please express mail the I-20.
You pay in advance. We will email you the discounted price.
Express mail will be used at the discretion of the Tutorium.
Local contact
Other:
IMPORTANT: PHOTOCOPIES OR FAXES OF FINANCIAL DOCUMENTS ARE NOT ACCEPTED.
ADMISSION INFORMATION
The Tutorium admits students 17 years or older with the equivalent
of a U.S. high school education. Documentation may be requested.
The Tutorium follows the nondiscrimimation policy of UIC:
https://tigger.uic.edu/depts/oar/campus_policies/nondiscrimination_statement.html
Admission to the Tutorium does not constitute admission to the
University of Illinois at Chicago.
APPLICATION INSTRUCTIONS
1. Fill out the application form completely and accurately. Sign and
date the form.
2. Pay the nonrefundable application fee. Payment options:
By check or money order:
• from a U.S. bank or a bank with a U.S. affiliate
• payable to the University of Illinois
By Credit Card (Visa or Master Card):
• On our secure website www.paytie.com OR
• Fill out and sign the credit information box
3. If you require an I-20 for an F-1 visa to enter the U.S. or to transfer
from another U.S. school, follow the I-20 application instructions.
CREDIT CARD: (Visa, MasterCard or Discover ONLY)
Credit Card Number:
/
Exp. Date: month/year
4. Send to:
University of Illinois at Chicago
Tutorium in Intensive English (M/C 324)
1333 South Halsted Street, Suite 260
Chicago, Illinois 60607-5019
U.S.A.
APPLICATION DEADLINE
The application deadline is determined by the number of applications
received. Enrollment is limited. Express mail will be used at the
discretion of the Tutorium. Late applications will be processed for the
following session.
PAYMENTS AND REFUNDS
Fees must be paid in full by the due date. We must receive your
payment on or before the due date to guarantee registration. If you can
not attend the session you originally apply for, notify the Tutorium. The
nonrefundable application fee is valid for three consecutive sessions.
There are no institutional scholarships or financial aid for Tutorium
students.
A full refund of fees, minus applicable service charges, not including
application fee, is issued if the Tutorium receives notification before the
Placement Examination. A partial refund is issued through the second
week of class. No refunds are made after the second week of class.
A processing fee is assessed for transfer requests prior
to enrollment.
Signature: ___________________________________________