Iowa Intensive English Program

APPLICATION FORM

This application for admission is for the IIEP Session beginning in
January May August Year: _________

Please send me University housing information yes no

__________________________________________ _______________________________________________
Family Name Given Name

Gender: Male Female

Permanent Address:
Street: __________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________ _______________________________________________
City or town Province or state

Country _________________________________ Postal Code ______________

 

Mailing Address:
Street: __________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________ _______________________________________________
City or town Province or state

Country _________________________________ Postal Code ______________

Birthplace city and country: ________________________________________________________

Birth date (month/day/year): _______________________________________________

Social Security Number (if you have one) ___________________________________________

Country of Citizenship ____________________________________________________________

Native Language ________________________________________________________________

Telephone _____________________________________________________________________

E-mail address __________________________________________________________________

Which members of your family (if any) will accompany you to Iowa City? Attach separate sheet if more than 2 people will accompany you.

___________________________________
___________________________________
Name Relationship to you
___________________________________ ___________________________________
Place of birth Date of birth
___________________________________ ___________________________________
Name Relationship to you
___________________________________ ___________________________________
Place of birth Date of birth

Are you interested in obtaining conditional admission to an undergraduate program at The University of Iowa? yes no

Have you applied for admission to The University of Iowa? yes no
If yes, graduate or undergraduate?

IMPORTANT NOTE: If you want to receive conditional admission to an undergraduate program at the
University of Iowa, you must also apply through the University of Iowa International Undergraduate Admissions.

 

How or where did you hear about the IIEP? Friends Former IIEP student web site (which one?)_________________________________________________
Educational counseling agency (Name) _______________________________________________
Other (Please specify) ___________________________________________________________

English Language Background and Education

Formal Instruction in the English Language:
Number of years in Secondary School _______ In College or University _______ Other ______

Have you taken the TOEFL exam? yes no. If yes, what was your score? _________

High School attended (Secondary School) _______________________________________________

Date of Graduation _____________________________________________________________

College or University ____________________________________ Years attended ________________

Immigration Status Information

Answer the following questions if you are currently living in the United States:

When did you arrive in the U.S.? (month/day/year)___________________________________________

What type of visa do you hold?
Student (F-1, F-2) Exchange Visitor (J-1, J-2) Tourist (B-1, B-2) Other __________

What is the expiration date on your Form I-94? _____________________________________________

If you hold a student visa, what school are you currently attending?
_________________________________________________________________________________

What is your SEVIS ID number on your I-20? ________________________________________________

 

Financial Statement

Immigration regulations require that the IIEP have written proof that an applicant has sufficient funds to pay all expenses while studying in the U.S.A. before a Form I-20 can be issued. If you wish to receive the immigration Form I-20 for an F-1 (student) visa, you must complete the following:

I will be funded by:

Personal funds

Parent/relative (signature) ___________________________________________________________

Relationship to applicant ______________________________________

Scholarship ____________________________________________________________________

Name, address, and phone number of sponsoring organization

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Please include the following financial guarantee information. Items must be originals. Faxes or copies are not acceptable. See calendar and costs for minimum funds needed and examples of financial guarantees.

A current bank statement indicating funds to cover one 16-week semester of study (currently $8,150) and an affidavit of support letter from financial sponsor (parent/relative).

OR

A current scholarship award letter indicting level, amount, and dates of support.

Please send a copy of the page in your passport that contains your picture and the exact spelling of your name. If you do not have a passport yet, please be sure your full name on the application is spelled clearly, exactly as you expect it to appear on your passport.

Applicant's Personal Statement

  1. I am able to pay for all the necessary school and living expenses.
  2. I guarantee that I will not put any financial burden on the Iowa Intensive English Program and that I will pay tuition and medical insurance when they are due.
  3. I understand that once I am registered, I am responsible for paying all my tuition and fees.
  4. I understand that a student (F-1) visa does not allow me to work except on campus.
  5. I understand that I must follow the rules and regulations of the U.S. government and the IIEP.
  6. I understand that I must attend all the classes to which I am assigned in the IIEP.
  7. I certify that all the statements on this application are true and correct to the best of my knowledge.
_______________________________________________
_______________________________________________
Signature of Applicant
Date of Signature

Mail the application with $340 (includes a non-refundable $50 application fee, a non-refundable $250 tuition deposit, and a $40 express mailing fee) to:

Iowa Intensive English Program
1112 University Capitol Centre
The University of Iowa
Iowa City, IA 52242
USA

Make check or money order payable to The University of Iowa. Credit cards are not accepted.

There is no deadline for submission of applications; however, applying early is important.  Each semester applications are accepted until the program is filled. 

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©The University of Iowa (2005)
Revised October 12, 2005