enroll app

8/12/2019 Enroll App

1/8

explore. experience. expand.

American Language CenterYour English Connection to the World

2014 Enrollment Application

Mail or email all documents to:

UCLA Extension

10995 Le Conte Avenue

Room 139, Main Cashiers Office

Los Angeles, CA 90024, U.S.A.

[email protected]

For questions, please contact the American Language Center

Phone: (310) 825-9068

Email: [email protected]


2/82

Here is a list of important issues to keep in mind as you complete the enrollment application. Please follow all directions carefully.

If you have questions or concerns, please contact the American Language Center (ALC) by phone at (310) 825-9068 or by email at

[email protected], and we will be happy to assist you.

1. Minimum Age:You must be at least 18 years of age on or before the start of the program you wish to enter. For example, for a program

beginning on June 25, 2014, your date of birth must be on or before June 25, 1996.

2. Student (F-1) Visa:If you are coming from another country to study in a full-time ALC program, you will need a student (F-1) visa.

Tourist (B-1/B-2) visas are not acceptable for full-time ALC intensive English programs, regardless of the program length.

3. Family Members Who Also Wish to Study Full-Time:If family members are coming with you to the U.S., and they also want to study full-

time in the U.S., they will need to submit enrollment applications and obtain student (F-1) visas.

4. Student and Exchange Visitor Information System (SEVIS) Fee:Once you receive your ALC admission documents and I-20, you must

pay the SEVIS fee. The SEVIS fee must be paid and recorded in SEVIS before your visa interview. We strongly recommend that you pay the

fee online at www.fmjfee.com.You will nd complete information on that website.

5. Obtaining an F-1 Visa:For information on the visa interview, visa application fees (MRV fees), and F-1 visas, check with the U.S. Embassy

or Consulate in your country.

6. Housing Options:Information is provided on our website at uclaextension.edu/alc .

A. Off-campus, Non-UCLA Housing: All off-campus, non-UCLA housing reservations, contracts and arrangements are made between the

students and the housing providers and are not the responsibility of the American Language Center. You must make housing payments to

the off-campus, non-UCLA housing provider directly. The UCLA Extension American Language Center cannot process these payments.

B. On-campus, UCLA Summer Housing:UCLA on-campus housing is available for our summer programs only. The 2014 housing fees

were not available when this application was published; however this information should be available in early 2014. For information about

UCLA on-campus housing, please contact the UCLA Extension American Language Center.

7. Payment:Credit card payments are preferred in all circumstances. Although we will process your initial enrollment application once we have

received the application fee, your enrollment will not be complete until you pay the program fee and student services fee. Please keep this in

mind if you are applying for more than one program. Programs may ll up before the payment deadline (on page 3), and we cannot reserve

your space without full payment.

A. Nonrefundable Application Fee:The nonrefundable $150 application fee must be paid before you submit your application. This payment

is valid for one year.

B. Program Fee and Student Services Fee:Both fees are mandatory for all students.

8. Refunds:For information about refunds, see the Cancellation, Refund, and Transfer Policy on page 7.

9. Late Arrival Deadlines:All students must arrive by the rst Friday of the program in order to attend.

10. Please bring the following on the rst day of the program:

One ofcial passport-sized (3.5 cm x 4.5 cm) or smaller photo for your ALC student identication card

Passport A copy of your I-20 with the U.S. port of entry stamp

Your local address in Los Angeles

UCLA Extension American Language Center 2014 Important Reminders
http://www.uclaextension.edu/alchttp://www.uclaextension.edu/alc


3/83

UCLA Extension American Language Center 2014 Deadlines

Winter 2014Program Program Dates Recommended Total Program & Check, Credit Card, Bank Wire Transfer

Application Student Services* and/or Money Order Payments Due BySubmission Date Fees Due Payments Due By

AIEP January 6-March 14 November 11, 2013 $5,285 December 16, 2013 November 25, 2013IECP - 12 January 6-March 27 November 11, 2013 $6,480 December 16, 2013 November 25, 2013IECP - A January 6-January 30 November 11, 2013 $2,350 December 16, 2013 November 25, 2013IECP - B February 4-February 27 December 9, 2013 $2,350 January 20, 2014 December 16, 2013IECP - C March 3-March 27 January 6, 2014 $2,350 February 17, 2014 January 20, 2014

Spring 2014

Program Program Dates Recommended Total Program & Check, Credit Card, Bank Wire TransferApplication Student Services* and/or Money Order Payments Due BySubmission Date Fees Due Payments Due By

AIEP March 31-June 6 February 3, 2014 $5,285 March 17, 2014 February 17, 2014IECP - 12 March 31-June 19 February 3, 2014 $6,480 March 17, 2014 February 17, 2014IECP - A March 31-April 24 February 3, 2014 $2,350 March 17, 2014 February 17, 2014IECP - B April 28-May 22 March 3, 2014 $2,350 April 14, 2014 March 17, 2014IECP - C May 27-June 19 March 31, 2014 $2,350 May 12, 2014 April 14, 2014

Summer 2014

Program Program Dates Recommended Total Program & Check, Credit Card, Bank Wire TransferApplication Student Services* and/or Money Order Payments Due BySubmission Date Fees Due Payments Due By

AIEP - A June 23-September 12 April 28, 2014 $5,680 June 9, 2014 May 12, 2014AIEP - B June 23-August 1 April 28, 2014 $2,980 June 9, 2014 May 12, 2014AIEP - C August 4-September 12 June 9, 2014 $2,980 July 21, 2014 June 23, 2014IECP - A June 30-July 24 May 5, 2014 $2,350 June 16, 2014 May 19, 2014IECP - B July 28-August 21 June 2, 2014 $2,350 July 14, 2014 June 16, 2014IECP - C August 25-September 12 June 30, 2014 $1,870 August 11, 2014 July 14, 2014

Fall 2014Program Program Dates Recommended Total Program & Check, Credit Card, Bank Wire Transfer

Application Student Services* and/or Money Order Payments Due BySubmission Date Fees Due Payments Due By

AIEP September 29-December 5 August 4, 2014 $5,285 September 15, 2014 August 18, 2014IECP - 12 September 29-December 18 August 4, 2014 $6,480 September 15, 2014 August 18, 2014IECP - A September 29-October 23 August 4, 2014 $2,350 September 15, 2014 August 18, 2014IECP - B October 27-November 20 September 1, 2014 $2,350 October 13, 2014 September 15, 2014IECP - C November 24-December 18 September 29, 2014 $2,350 November 10, 2014 October 13, 2014

Credit Card payments are recommended and must be made online at uclaextension.edu.If sending payment by check, please make payable to the Regents of U.C. We recommend that checks be sent by DHL, FedEx, UPS, or another express mail courier win advance of the payment deadline.

UCLA Extension Cashiers Ofce

Attn: ALC10995 Le Conte Avenue, Room 139

Los Angeles, CA 90024

Please contact the American Language Center at [email protected] you would like to pay by bank wire transfer. Specic documents must be submittedorder to pay by bank wire transfer.

*Student Services Fee includes:

Injury and Sickness Insuranceallows students to visit a hospital or clinic if medical attention is needed due to an injury or sickness (Please note: insurance prices asubject to periodic increases, and permanent residents of the United States will not be eligible for this insurance)

Academic Advisingquarterly orientations regarding American universities, UCLA Extension certicate programs, and assistance with application procedures and fo Language/Computer Labup to 8 hours per week of extra, after-school access to state-of-the-art language practice, email, and internet Housing Detailsinformation is provided about nding a place to live (Please note: UCLA on-campus housing is available for intensive programs in the summer only

Prices for 2014 summer on-campus housing have not yet been determined. Please look for detailed summer housing information and pricing in early 2014.) Language Exchange Programopportunities to meet members of the local community and UCLA for conversation practice UCLA Recreation Facilitiesaccess to many of UCLAs outstanding sports and recreational facilities

Express Mailapplication and program materials sent via express mail

1. Applications are accepted until programs are full. Applying before the deadline will improve your chances of getting a space. We recommend allowing at least8 weeks to obtain an F-1 visa.

2. Although we will process your initial enrollment application once we have received the application fee, your enrollment will not be complete until you pay theprogram fee and student services fee. Please keep this in mind if you are applying for more than one program. Programs may ll up before the payment deadline,and we cannot reserve your space without full payment.

3. The nonrefundable $150 Application Fee must be paid before you submit your application. This payment is valid for one year.

4. The Program and Student Services Fees are mandatory for all students.
http://www.uclaextension.edu/http://www.uclaextension.edu/http://www.uclaextension.edu/


4/84

UCLA Extension American Language Center 2014 Enrollment Application Checklist

Age & Visa Requirements:

Students must be at least 18 years of age by the program start date.

The American Language Center (ALC) full-time Academic Intensive English Program (AIEP) and Intensive English Communication Program(IECP) require an F-1 student visa. Tourist visas (B1/B2) are not acceptable for full-time ALC intensive English programs, regardless of pro-gram length. Please follow the steps below carefully so that we can process your application and issue an I-20 document.

Enrollment Steps:Email the below items as PDF les to [email protected].

1. Application Form:Complete the application form (pages 5 and 6). Indicate your program selection by marking the program(s) andsession(s) you will attend. Please type or print clearly in blue or black ink.

2. Payment:Go to uclaextension.eduto pay. The nonrefundable $150 application fee is required before you submit your initial applica-tion; program and student services fees are due for new students by the payment deadline on page 3. Continuing students must payprogram and student services fees when submitting the application to be enrolled. Please follow these payment instructions:uclaextension.edu/applyfees.

3. Enrollment Confrmation:Please submit a copy of the Enrollment Conrmation with your application. You will receive an EnrollmentConrmation with your student ID number by email once you have paid. Please add your student ID number to page 5 of your application.

4. Passport Copy:Make a clear, readable copy of your passport page showing your name, date of birth, passport expiration date, andphotograph. If your spouse (husband or wife) and/or children will come with you on an F-2 visa, please also include a clear copy of yourspouses/dependents passport page(s).

5. Financial Certifcation

A. Sponsor Statement (must be in English)can be lled out in section 4A of the application form or attached as a separate document.

B. Verication of Bank Funds (must be in English)can be lled out in section 4B of the application form or attached as a separatedocument.

(Both A and B must be dated within 60 days from the date your application is received.)

6. Transfer Students: This section is only for F-1 students transferring from another school in the United States. Please also submit:

A. An ofcial American Language Center SEVIS Transfer Form signed by the school you have been attending (with the beginning andend dates of attendance and your SEVIS I-20 release date). Please contact ALC for the form.

B. A copy of your most recent I-20

C. A copy of your F-1 visa and your spouses/dependents F-2 visa D. A copy of your I-94 card or a copy of your electronic I-94 form (www.cbp.gov/I94).

E. Full payment of application, program, and student services fees (Please follow the payment instructions in step #2 if you have notyet paid.)

We look forward to welcoming you! If you have questions, we will be happy to assist you. Please contact us at:

American Language Center Phone: (310) 825-9068

UCLA Extension [email protected] Le Conte Avenue, Room 614 Website: uclaextension.edu/alcLos Angeles, California 90024-1333 U.S.A. Facebook: facebook.com/alcucla
http://www.uclaextension.edu/http://www.uclaextension.edu/applyfeeshttp://www.uclaextension.edu/alchttp://www.facebook.com/alcuclahttp://www.uclaextension.edu/applyfeeshttp://www.uclaextension.edu/http://www.facebook.com/alcuclahttp://www.uclaextension.edu/alc


5/85

1. Student ID Number:_____________________________________

Your student ID number is listed on the Enrollment Conrmation

that is emailed to you after you pay online. Please do not submit

your application without your student ID number. Keep a copy of the Enrollment Conrmation for future reference.

Print your name exactly as it appears on your passport.

Family Name(Surname/Family Name as shown on your passport)

First Name(Given Name as shown on your passport) Middle Name

Student Email Address(this email address must be used when paying online) _____________________________________________

Date of Birth(Month/Day/Year): ____________________ Male Female

2. Program Selection: Please mark the program(s) that you want to attend. Next to each fee listed below, you will see a Project ID number. Payonline by entering the Project ID number in the Quick Enroll section of the UCLA Extension website. The nonrefundable $150 ApplicationFee is due once per year.

PAYMENT OF FEES

New ALC Students:We will reserve a space in your rst program when you pay the $150 application fee. The Student Services Fee andProgram Fee are due by the payment deadline of your rst program (see page 3). If you would like to enroll in multiple programs, you must paythe Student Services Fees and Program Feeswe cannot hold your space for additional programs without payment.

Continuing ALC Students or Students Transferring from Another School:You must pay all fees (the Student Services Fee and ProgramFee) in order to reserve your space in each program. Programs may ll up before the payment deadline, and we cannot reserve a spacewithout full payment. Selecting programs on the application without paying does not mean that you are enrolled.

For Representatives/Agencies Only:

Customer ID:_______________ Agreement No.:_____________________

Agency Name: _________________________________________________

Representative Name: ___________________________________________

Representative Email:____________________________________________

Student will pay. Please do NOT issue an agency invoice.

Agency will pay. Please issue an agency invoice.

Is this a group enrollment? Yes No

Name of Group: ________________________________________________

To complete your enrollment, please submit this appli-cation, payment, and all documents from the checklistas PDF les to [email protected]

Quarter Program Dates Program Length Application Fee Project ID Student Services Fee Project ID Program Fee Project ID

Winter 2014 Jan 6-Mar 14 10 weeks $150 242-407 $870 242-408 $4,415 241-973

Spring 2014 Mar 31-Jun 6 10 weeks $150 242-409 $870 242-410 $4,415 241-974

Summer 2014 A Jun 23-Sep 12 12 weeks $150 242-411 $1,005 242-412 $4,675 241-975

Summer 2014 B Jun 23-Aug 1 6 weeks $150 242-413 $610 242-414 $2,370 241-976

Summer 2014 C Aug 4-Sep 12 6 weeks $150 242-415 $610 242-416 $2,370 241-977

Fall 2014 Sep 29-Dec 5 10 weeks $150 242-417 $870 242-418 $4,415 241-978

Quarter Program Dates Program Length Application Fee Project ID Student Services Fee Project ID Program Fee Project ID

Winter 2014 12 Jan 6-Mar 27 12 weeks $150 242-419 $1,055 242-420 $5,425 241-979

Winter 2014 A Jan 6-30 4 weeks $150 242-421 $475 242-422 $1,875 241-983

Winter 2014 B Feb 3-27 4 weeks $150 242-423 $475 242-424 $1,875 241-984Winter 2014 C Mar 3-27 4 weeks $150 242-425 $475 242-426 $1,875 241-985

Spring 2014 12 Mar 31-Jun 19 12 weeks $150 242-427 $1,055 242-428 $5,425 241-996

Spring 2014 A Mar 31-Apr 24 4 weeks $150 242-429 $475 242-430 $1,875 241-986

Spring 2014 B Apr 28-May 22 4 weeks $150 242-431 $475 242-432 $1,875 241-987Spring 2014 C May 27-Jun 19 4 weeks $150 242-433 $475 242-434 $1,875 241-988

Summer 2014 A Jun 30-Jul 24 4 weeks $150 242-435 $475 242-436 $1,875 241-989Summer 2014 B Jul 28-Aug 21 4 weeks $150 242-437 $475 242-438 $1,875 241-990

Summer 2014 C Aug 25-Sep 12 3 weeks $150 242-439 $410 242-440 $1,460 241-991Fall 2014 12 Sep 29-Dec 18 12 weeks $150 242-441 $1,055 242-442 $5,425 241-992

Fall 2014 A Sep 29-Oct 23 4 weeks $150 242-443 $475 242-444 $1,875 241-993Fall 2014 B Oct 27-Nov 20 4 weeks $150 242-445 $475 242-446 $1,875 241-994

Fall 2014 C Nov 24-Dec 18 4 weeks $150 242-447 $475 242-448 $1,875 241-995

UCLA Extension American Language Center

Academic Intensive English Program (AIEP):

Intensive English Communication Program (IECP):

2014 Enrollment Application
http://www.uclaextension.edu/http://www.uclaextension.edu/


6/86

4. Financial CerticationYou and/or your sponsor are nancially responsible for your educational and

living expenses for the duration of your educational program as well as for the

educational and/or living expenses of your husband, wife, and/or children who will

accompany you. Additionally, UCLA Extension may share information from youracademic record with your nancial sponsor.

Calculation of Financial Support

You may use the following table to calculate your educational and living expensesbefore you complete sections A and B at the right.

A. Sponsor Statement (must be in English)

I have read the information regarding the cost of the program and living expensfor the period of study at UCLA Extension American Language Center. I certifythat these funds are available for the student and accompanying family membeI accept full responsibility for these expenses and have included fund vericatiofrom my bank.

This section must be signed only by the bank account holder.

Name:_________________________________ Relationship: _____________ (self, father, mother, friend,

Street: ___________________________________________________________City: _____________________________________ State: __________________

Country: __________________________________ Postal Code: ____________

Signature: ________________________________ Date: __________________

Check here if you are submitting a separate letter of sponsorship,

signed and dated within the last 60 days, which states the amount

of nancial support and the relationship to the student, instead of

completing A above.

B. Verication of Bank Funds (must be in English)

This is to certify that the applicant or sponsor listed above is nancially capableof meeting the minimum funds required for the program, which includes funds husband, wife, and/or children. If the funds are outside the United States, the aplicant is permitted to use them under his/her governments present regulation

Name of Bank Ofcial: _____________________________________________

Title of Bank Ofcial: ____________________________

Bank Ofcials Signature ________________________

Date (within the last 90 days) _____________________

Check here if you are including an original bank letter written on ofc

bank stationery (dated within the last 60 days) instead of completing

above.

5. Student Terms of Agreement:

I agree that all information is accurate and that I have read and agree to accept the UCLA Extension American Language Center refund policy.

Name:_______________________________________________________ Date (month/day/year): _______________________

Name as shown on passport (Family Name, First Name, Middle Name)

Student Email Address: ________________________________________________

Country of Birth: ______________________________________________________

Country of Citizenship: _________________________________________________

Students Permanent Home Country Address(required)cannot be apost ofce box:

Street: ______________________________________________________________

City: _____________________________________________ State: ___________

Country: _______________________________ Postal Code: _______________

Tel: _______________________________ Fax: ___________________________

Mailing Address

*If you are a transfer student, you must include an address in Los Angeles below.

Check this box if your mailing address is the same as your permanent address.

Street: ______________________________________________________________

City: _____________________________________________ State: ___________

Country:__________________________________ Postal Code: ______________

Tel: _______________________________ Fax: ____________________________

Emergency Contact Information(in the U.S. or in your home country)

Home Country Contact Persons Name: ________________________________

Relationship: __________________________ Tel: ______________________ (father, mother, friend, etc.)

Email: ___________________________________________________________

Local Contact Persons Name: _______________________________________

Relationship: _________________________ Tel: _______________________ (father, mother, friend, etc.)

Email: ___________________________________________________________

This person is allowed to discuss my application with the American LanguageCenter:

Name: ___________________________________________________________

Email: ___________________________________________________________

Bank Stamp or Se

(This is not aguarantee of fund

3. Student Details

Is this your rst time studying at the ALC? Yes No

Are you transferring to the ALC from another school in the U.S.? Yes

If yes, name of the school:____________________________________________

Will you need special services to accommodate a physical, perceptual,

learning disability? Yes No

If yes, please explain (attach separate page if you need more room):

_________________________________________________________________

Will a husband, wife, and/or children accompany you with a F-2 visa?

Yes No If yes, please list:

1. Name: ____________________________________________________________ (Family Name, First Name as shown on your passport)

Country of Birth:_________________________ Date of Birth: ______________

Country of Citizenship: ____________________ Relationship: _______________

2. Name: ____________________________________________________________ (Family Name, First Name as shown on your passport)

Country of Birth:_________________________ Date of Birth: ______________

Country of Citizenship: ____________________ Relationship: _______________

Include a copy of each dependents passport page showing the photo identica-tion and attach an extra sheet for additional dependents.

Duration ofStay

StudentsEducation &

Living Expenses

+

Spouse

+

Each Child

Total

3 or 4 weeks $4,188 $584 $384 $6 weeks $5,662 $876 $576 $10 weeks $9,655 $1,460 $960 $12 weeks $11,694 $1,752 $1,152 $

Minimum Funds Required for Program


7/87

2014 American Language Center Cancellation, Refund, and Transfer PolicyAll cancellation, refund, and transfer requests must be submitted on an ALC Cancellation, Refund, and Transfer Request Form and are subject

to approval by American Language Center (ALC) management. If payment was made by credit card, in most instances, a credit will appear on the

same credit card used (allow 3-5 weeks for processing). If payment was made by check, cash, or bank wire transfer, a refund check will be issued

(allow 6-8 weeks for processing). There is a $30 processing fee for each refund issued, and this fee is subject to change.

A. Nonrefundable Application Fee

All application fees must be paid before submitting the application. The American Language Centers (ALC) program application and housing

application fees are non-refundable.

B. Cancelling Programs Prior to Arrival in the U.S.

Students who cancel prior to arrival in the U.S. must submit a Cancellation, Refund, and Transfer Request Form prior to the start date of their

program to receive a refund.

Students who have been denied a student (F-1) visa must submit a Cancellation, Refund, and Transfer Request Form by Friday of the rst week

of the program. A visa denial letter in English is required if a refund is requested due to a visa denial and if the request is submitted after the

program start date.

If we receive a request after the deadlines above, the student will not receive a refund.

C. Deferring Programs Prior to Arrival in the U.S.

In order to defer programs, students must submit a Cancellation, Refund, and Transfer Request Form on or before the Friday of the rst week o

the program. A new application also must be submitted at this time with a new program start date. If all required documents are submitted, ALC

can transfer the original payment to an available future program. A $125 program transfer fee will be collected if a deferral request is receivedafter the program start date.

D. Cancelling Programs after Arrival in the U.S.

No refund will be granted if students enter the U.S. with government documents indicating that they plan to study at UCLA Extensions Ameri-

can Language Center and if they do not enter a UCLA Extension program. Continuing students who wish to cancel subsequent programs must

submit a completed Cancellation, Refund, and Transfer Request Form prior to the program start date. If we receive a request after the deadlines

above, the student will not receive a refund.

Under special circumstances, students may receive an eighty percent (80%) refund if the Cancellation, Refund, and Transfer Request Form is

received by the Friday of the rst week of their ALC program and is approved by the Program Manager. No refunds will be approved after the

Friday of the rst week of the program.

If a students I-20 expires through no fault of UCLA Extension-ALC, a refund will not be issued.

If students arrive after the Friday of the rst week of the program, they will not be able to attend and will not receive a refund.

E. Transferring from One ALC Program to Another ALC Program

All transfers between ALC programs within the same quarter must be requested using the Cancellation, Refund, and Transfer Request Form

and approved by the Program Manager or Academic Advisor. There will be a transfer fee of $125. The transfer fee is due at the time of the new

enrollment. A new ALC enrollment application must be completed, and payment for the new program must be submitted. No transfer requests

will be approved after the rst Friday of the program.

F. Transferring to Another School

If you plan to transfer to another school after attending ALC programs, please contact the UCLA Extension International Student Ofce:

[email protected].

If you plan to transfer to another school instead of attending an ALC program, you will need to ll out a Cancellation, Refund, and Deferral Request

Form and refer to section D above regarding the refund. Then contact the International Student Ofce regarding transferring to another school.

* You can nd the Cancellation, Transfer, and Refund Request Form on our website at uclaextension.edu/alc, or you can request a form by

emailing [email protected] by calling (310) 825-9068.
http://www.uclaextension.edu/alchttp://www.uclaextension.edu/alc


8/88

Please print clearly:

Student Name: ___________________________________________________________________________________________________ Family Name First Name Middle Initial

Date of Birth (month/day/year):_______________________________ Student ID Number: ___________________________________

If applicable, agency name: _________________________________________________________________________________________

Address to send refund: ____________________________________________________________________________________________

Email Address: _____________________________________________

Phone Number:_____________________________________________

Current Program: AIEP (Academic Intensive English Program)

IECP (Intensive English Communication Program)

ACC Course (American Culture and Communication Coursemornings only)

I am requesting a: cancellation from the following program:

AIEP start date: ________________

IECP start date: ________________

ACC Course start date: ________________

transfer to the following program (a new application form is required):

AIEP start date: ________________

IECP start date: ________________

ACC Course start date: ________________

Reason for request:

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

I have read and understand the ALC Cancellation, Refund, and Transfer policy (see page 7):

Student Signature:___________________________________________ Date (month/day/year):________________________________

For administrative use only:

Refund: F prog & ss 80% prog & ss Transfer Fee Other____________________________

Approved by 1)____________________________________ 2)____________________________________

Denied___________________________________________ Date (month/day/year):__________________

2014 American Language Center Cancellation, Refund, and Transfer Request Form

enroll app

Documents