Dependent Form - American Language Center

Dependent F-2 Visa Form

Address (In the United States):

Country of birth:(required)
Country of citizenship:(required)
Your Native Language(required)
Marital status (required)
Spouse’s Name (If married)
Social security Number (If any)
Email(valid email required)
Emergency contact name: (First and last name)
Emergency contact phone number (in the United States preferred):
Program
Based on your own opinion/self-assessment, select your level of English. (Your official level will depend on the placement test)
Why do you want to study English?
How did you hear about us?

F-1 students transferring to American LC only

Which institution (College, university or another ESL school) in the United States are you transferring from?
Provide the name of the international student advisor at your current school
Provide the email address or FAX number of your student advisor
Date of your last attendance

International Students Only

- Place of birth

- Your permanent address outside of the United States

House Number, Street Name and Apartment Number:(required)
City or town:(required)
State/Region/Province:(required)
ZIP Code/Postal Code:(required)
Country:(required)
Are you currently or have you ever been a J-1 or J-2 visa holder?
YesNo
List all "from" and "to" dates when you held J-1 or J-2 visa
1. Arrival - departure date. Example: 05/01/2012 - 09/01/2012
2. Arrival - departure date. Example: 05/01/2012 - 09/01/2012
3. Arrival - departure date. Example: 05/01/2012 - 09/01/2012
Name and address of your employer/company you work for, weekly income, and explain whether employment was authorized by USCISN/A
First and Last Name of the Principal (F-1) applicant(required)
I certify that the above information is true and correct. I confirm that I have reviewed American LC fees, tuition schedule, refund and school policies, and I understand that I am fully liable for any unpaid or past due balance.
I agree