Last Name________________First Name___________Middle Name_____

Street Address___________________________________________________

City/Town_____________________State/Province____________________

Country_______________________US Zip Code_______________________

Country Code____________(if available) Telephone__________________

Country of Citizenship___________Country of birth__________________

Nationality________________________________________ □Male □Female

Applicant's Date of Birth: Month___________Day_______Year________

Are you a high school graduate:______ Years attended______________

Year of graduation______Name of High School______________________

Country/State____________________________________________________

College or institution of higher learning attended (if any):

(1) Name:____________________(2) Name:____________________________

(1) Years attended:___________(2) Years attended:___________________

Degrees, diplomas, or certificates received:

(1) a.____________________________(2) a._____________________________

(1) b.____________________________(2) b.____________________________

(1) c.____________________________(2) c._____________________________

List any special training or work experience received in a related field.

(1)__________________________________________________________________________________________________________________________________.

(2)__________________________________________________________________________________________________________________________________.

If under 18 years of age, give the following information:

Father's Name:________________________Telephone:________________________ Address:________________________________________________________________

Mother's Name:________________________Telephone:________________________ Address:_________________________________________________________________

SECTION D:

Do you suffer from any physical disability? □Yes □No

If so, please explain briefly:_____________________________________________

Do you suffer from any of the following: □Epilepsy □Arthritis □Rheumatism other:___________________________________________________________________

Name and telephone number of the person(s) to be notified in the event of an emergency: _____________________________________________________________

Projected starting date of attendance? ______________Month___________Year

Following is a list of items that must be mailed with this application:

(1) Please attach bank letter or financial statements showing support for a period of not less than 12 months attendance at the Institute (support may be shown from one or more sources).

(2) Two passport size photographs to accompany this application.

(3) A check in the amount of US $150.00 as an enrollment fee, which will be applied towards tuition if you are accepted and refunded in full if you are not accepted or fail to obtain a student visa.

NOTE:

(a) Upon receipt of all completed documents, an I-20 form completed and signed by the Institute will be mailed to the applicant.

(b) Please allow four to six weeks for a response from the date the application was received by the Institute.

Projected starting date of attendance? ____________Month___________Year

(1) Two passport size photographs to accompany this application.

(2) A check in the amount of US $150.00 as an enrollment fee, which will be applied towards tuition if you are accepted and refunded in full if you are not accepted.

NOTE: Please allow 4 weeks for a response from the date the application was received by the Institute.

1. All applications will be handled and filed according to the date each application is received. In the event current classes are filled, the Institute reserves the right to set a new enrollment date for the next available class.

Signature of parent or guardian if applicant is under 18years of age:

Signature______________________First_____________Last__________

Applicant's Signature______________________First_____________Last___________

Date__________________