Instructions:
Please print this application, complete all sections, include an application fee of $50 (US dollars), and mail to:
English Language Program
205 Fairchild Hall
Kansas State University
Manhattan KS 66506-1106 U.S.A.
Phone: 01-785-532-7324
Fax: 01-785-532-6550
E-Mail: elp@ksu.edu
Name:
(last/ family) _______________________________________________________
(first)_____________________________________________________________
(middle)___________________________________________________________
Address:__________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
E-Mail:______________________________
Telephone: (area code) (________)____________________
FAX: (area code) (________)____________________
Sex: ____Female ____Male
Birth Date: (month)________________ (day) _________________(year)_______________
Birthplace: (city)____________________________ (country)_______________________
Country of Citizenship:_____________________________________
Do you need an I-20 Form? ______Yes ______No
If no, with which visa will you enter the U.S.?___________________
Marital Status: ______Single _____Married
Will spouse accompany you? _____Yes _____No
(If yes, include a separate paper with name, date, and place of birth.)
Will children accompany you? _____Yes _____No
(If yes, include a separate paper with name, date, and place of birth of each. They will need their own documents to enter the U.S.))
If you are now in the U.S.:
When did you arrive?________________________
What type of visa do you hold?
Student _____________________ Exchange Visitor ____________________
Other (specify type) ___________________________________
For which semester are you applying?:
_____Fall (August - December) ______________(year)
_____Spring (January - May) ________________(year)
_____Summer (June - July) __________________(year)
Study Plans
After completing the English Language Program do you wish to study at Kansas State University? _____yes _____no
Have you been conditionally admitted? _____yes _____no
Have you been admitted as? _____Graduate _____Undergraduate
What is your major (area of concentration)?
_____________________________________________________________________
TOEFL score:____________ Date taken:_______________
Name of high school:____________________________________
Date of graduation:_____________________________________
Name of university:_____________________________________
Date of graduation:_____________________
Release of Records: I authorize the release of my admission records to my sponsoring agency, admissions office, or family member(s) as listed:____________________________________________________
Signature:_____________________________________________________________
AFFIDAVIT OF SUPPORT FOR__________________________________________
NAME OF APPLICANT
This document must contain all of the appropriate signatures and notarizations before a student is considered for admission to English Language Program. If separate statements from bank and sponsor are submitted, each must be original. Statements must be dated within one (1) year of your intended date of enrollment.
All documents must be addressed to Kansas State University, English Language Program, 205 Fairchild Hall, Manhattan, Kansas 66506-0102.
Certificates of balance showing only the amount of money on deposit are not acceptable. Monetary amounts must be stated in U.S. dollars.
STATEMENT FROM SPONSOR
I, _____________________________________________, do swear that I will make available to
NAME OF SPONSOR
________________________________________ a total sum of $23,515 U.S. dollars for each year of study
NAME OF APPLICANT
at Kansas State University. This money is in addition to any passage money needed for return to the country of origin. I understand that Kansas State University will not be able to assist the student financially. I, the undersigned, realize that I am fully responsible, and will be held accountable by the University, for maintaining the terms of this statement. I am not a nonimmigrant student and I do not hold any other temporary status in the United States.
My relationship to the applicant is ___________________.
______________________________________________ _________________________
SPONSOR'S SIGNATURE SEAL DATE
___ __________________________________________ _________________________
SIGNATURE OF NOTARY PUBLIC OR GOVERNMENT OFFICIAL DATE
_____________________________________________ ____________________________________________________
SPONSOR'S ADDRESS
STATEMENT FROM A BANK OR FINANCIAL ESTABLISHMENT
This is to certify that _________________________________, whose signature appears above as sponsor, is of a financial position to provide for expenses of the student applicant named. The statement and signature are given with the understanding this is not a guarantee and does not constitute any financial responsibility on the part of the signing individual or the institution they represent. NOTE: Statement from bank must be from sponsor's bank not from the student's bank.
If you have a scholarship a sponsoring agency, check here and attach a signed letter of financial support in English.
_________________________ _______________ ________________________________________
SIGNATURE OF BANK OFFICIAL TITLE OF BANK OFFICIAL
_____________________________ _____________________ ____________________________________________
NAME ADDRESS OF BANK
_____________________________ PLACE OFFICIAL BANK SEAL HERE:
DATE
VISA MASTERCARD
Card # Exp. Date
Cardholder's Name
Cardholder's Signature