Program Selection YOU MUST SELECT A PROGRAM below and select all the sessions you plan to attend for that program. Intensive Program Summer 1 2022 Summer 2 2022 Fall 1 2022 Fall 2 2022 University Connection or University Connection Plus (please see University Connection Plus test score requirements below) Summer 1 2022 Summer 2 2022 Fall 1 2022 Fall 2 2022 Institute for Academic and Professional Studies (This program may only be taken for one session) July 2022 Personal Information * Fields with an asterisk are required Family name: * First name: * Date of birth: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Country of citizenship: * Country of birth: * City of birth: * Native language: * 8-digit Penn ID: Permanent Address in Home Country Street address: * City: * State: * Country: * Postal code: * Home telephone: * Student email: * If you are a transfer student Please write your local address in the United States Street address: City: Postal code: Domestic telephone: Where should ELP send all information and I-20? * Home address above Agent/Sponsor If you selected Agent/Sponsor: Please write the Agent/Sponsor name here: Please write the Agent/Sponsor address here: Financial Support NOTE: A financial support document must show funds to pay the estimated tuition and living expenses for ALL sessions included on your I-20. You must send a statement showing sufficient funds for your study period. Intensive Program/University Connection: $9,407 per session University Connection Plus: $9,926 per session IAPS/IBC: $5,012 per session Who will pay for your tuition and living expenses? * Self Family in my home country An organization, company, or government Permanent U.S. resident If you selected "An organization, company, or government" above, please include name: Visa Information Please check one: I will apply for an F-1 student visa. Please send me an I-20 form. I will transfer my I-20 from another school. I am currently studying in the U.S. on an F-1 visa (See required documents below) I have been admitted to another department at Penn (name department below) I do not need an F-1 student visa If you selected “I have been admitted to another department at Penn,” Please write department name: If you selected "I do not need an F-1 student visa" above, please give reason: I am a U.S. citizen of permanent resident I have another type of visa that allows me to study in the U.S. Other If you selected "I have another type of visa" above, what is the type of Visa? Please email ELP a copy. NOTE: If you are a transfer student, you must also send the following: Official transcript from current school Copies of student visa, I-20, and CBP admission stamp (or print-out of I-94 admission number) Local address in the U.S. Completed Proof of Academic Success Form (ELP will provide this to you after you submit your application) Completed Transfer Form (ELP will provide this to you after you submit all documents) Dependents * Do you have dependents (spouse/children) that will come with you to the U.S.? Yes No NOTE: Students with dependents must include a copy of each dependent’s passport. Write the dependent’s country of birth, country of citizenship, and relationship to you on the passport copy. Financial support document must include an extra $550 per month per dependent. University Connection and University Connection Plus Students Only Which program are you applying to? University Connection University Connection Plus (UniConn Plus requires TOEFL iBT: 70) If you selected University Connection Plus: Your current TOEFL score: Session you would like to take UniConn Plus: What is your field of study/major? What degree are you seeking? Bachelor Master Doctoral When do you plan to start your degree program? Please list any colleges or universities you attended in the past or are attending now (include school name, location, enrollment, dates, degree) Institute for Academic and Professional Studies and Institute for Business Communication Students Home university: Field of study: How did you hear about Penn ELP? How did you hear about Penn ELP? Agent/Organization/Sponsor Education fair Friend or family member Magazine ELP website Other If you selected Other: Refund Policy Before classes start, students can receive a refund of tuition and fees minus the non-refundable $90 USD enrollment fee and the $310 USD tuition deposit. Before the first week of classes end, students can receive a refund of 75% of tuition minus the $90 USD enrollment fee and $310 USD tuition deposit. Fees, insurance, and housing are governed by separate policies and may not be refundable depending on when you withdraw. I have read and accept the Refund Policy * Yes Signature I certify that I have read and understand the information in this form, including the refund policy, and the information I have provided is accurate and complete. I understand that enrollment in this program does not constitute admission to any other program at the University of Pennsylvania. * Yes Enter name: Enter date: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202220232024202520262027
