Name: Last/Family name First/Given name Middle Sex: Female Male Birthdate: month/day/year Country of birth Country of citizenship Native language To ensure the correct spelling of your name on the I-20 form, please include a copy of your passport identification page with this application. Current address City State/Province Postal Code Country Telephone: Day Evening Email Application Tutorium in Intensive English This application is valid only if it has been signed by the applicant. Signature: ______________________________________________ Date:_____________ This application form can be filled out online and printed from our website www.uic.edu/depts/tie 1333 South Halsted Street, Suite 260, Chicago, Illinois 60607-5019, U.S.A. Telephone: (312) 996-8098 Fax: (312) 996-4394 Email: tutorium@uic.edu Website: www.uic.edu/depts/tie FIRST SESSION YOU WANT TO ATTEND: (Choose one) U.S. Immigration policy requires all applicants for F-1 visas to be full-time students. Fall (Monday – Thursday) Schedule (Choose one) Full-time Part-time Reading/Writing afternoon Part-time Listening/Speaking evening Spring (Monday – Thursday) Schedule (Choose one) Full-time Part-time Reading/Writing afternoon Part-time Listening/Speaking evening Summer (Monday – Friday) Schedule (Choose one) Full-time Part-time Reading/Writing morning Part-time Listening/Speaking afternoon Campus housing is available to Tutorium students. Would you like an application for on-campus housing? Yes No LOCAL CONTACT IN U.S.: Name: Last/Family name First/Given name Current address City State Postal Code Telephone: Day Evening Email Highest level of education you completed: High school College/University If you are in the U.S. now, your immigration status is (visa type): F-1 Resident/Citizen Other: Date of arrival in the U.S.: month/day/year I-94 card expiration date: month/day/year or, D/S Studying in the U.S. now: No Yes, Name of school: Applied to or attended the Tutorium in the past: No Yes, Session: Year: PERSONAL INFORMATION: / / / / / / Application continued Tutorium in Intensive English I-20 APPLICATION INSTRUCTIONS: (for F-1 student visa) To obtain an I-20 form you need to submit the following documents: • Complete application • Application fee • Proof of Financial Support P ROOF OF FINANCIAL SUPPORT: Indicate the source of support and follow the instructions. Student funds One original bank letter on bank letterhead. This letter must be no older than 6 months and the amount available must be no less than the ESTIMATED EXPENSES PER SESSION. This letter can show the amount in U.S. dollars or the equivalent of this amount in any other currency. If the letter is not in English, a translation must be attached. You will need a second bank letter to submit to the U.S. Embassy or Consulate when you apply for the F-1 student visa. Sponsor funds In addition to the bank letter from your sponsor, you must also submit a signed affidavit of support. Scholarship or other institutional support Submit an official letter from the sponsoring organization that states the specific amount of funds granted. If you are applying from overseas, please check with the U.S. consulate in your country for processing times and procedures, and begin the process as soon as possible. If you are transferring to the Tutorium from another school, submit the Transfer Verification Form available in the Tutorium Office or on-line at www.uic.edu/depts/tie. AFFIDAVIT OF SUPPORT: Name of sponsor (source of support while in the U.S.) Current address City State/Province Postal Code Country Telephone: Day Evening Relationship to student: PLEASE SEND I-20 TO: Student’s current address Please express mail the I-20. You pay in advance. We will email you the discounted price. Express mail will be used at the discretion of the Tutorium. Local contact Other: I do hereby declare that I am willing and able to financially maintain and support: Name of student: During his/her period of study at the Tutorium in Intensive English at the University of Illinois at Chicago. ___________________________________________________ Signature of sponsor: ADMISSION INFORMATION The Tutorium admits students 17 years or older with the equivalent of a U.S. high school education. Documentation may be requested. The Tutorium follows the nondiscrimimation policy of UIC: https://tigger.uic.edu/depts/oar/campus_policies/nondiscrimination_statement.html Admission to the Tutorium does not constitute admission to the University of Illinois at Chicago. APPLICATION INSTRUCTIONS 1. Fill out the application form completely and accurately. Sign and date the form. 2. Pay the nonrefundable application fee. Payment options: By check or money order: • from a U.S. bank or a bank with a U.S. affiliate • payable to the University of Illinois By Credit Card (Visa or Master Card): • On our secure website www.paytie.com OR • Fill out and sign the credit information box 3. If you require an I-20 for an F-1 visa to enter the U.S. or to transfer from another U.S. school, follow the I-20 application instructions. 4. Send to: University of Illinois at Chicago Tutorium in Intensive English (M/C 324) 1333 South Halsted Street, Suite 260 Chicago, Illinois 60607-5019 U.S.A. APPLICATION DEADLINE The application deadline is determined by the number of applications received. Enrollment is limited. Express mail will be used at the discretion of the Tutorium. Late applications will be processed for the following session. PAYMENTS AND REFUNDS Fees must be paid in full by the due date. We must receive your payment on or before the due date to guarantee registration. If you can not attend the session you originally apply for, notify the Tutorium. The nonrefundable application fee is valid for three consecutive sessions. There are no institutional scholarships or financial aid for Tutorium students. A full refund of fees, minus applicable service charges, not including application fee, is issued if the Tutorium receives notification before the Placement Examination. A partial refund is issued through the second week of class. No refunds are made after the second week of class. IMPORTANT: PHOTOCOPIES OR FAXES OF FINANCIAL DOCUMENTS ARE NOT ACCEPTED. CREDIT CARD: (Visa, MasterCard or Discover ONLY) Credit Card Number: Exp. Date: month/year Signature: ___________________________________________ / A processing fee is assessed for transfer requests prior to enrollment. . Reading/Writing afternoon Part-time Listening/Speaking evening Spring (Monday – Thursday) Schedule (Choose one) Full-time Part-time Reading/Writing afternoon Part-time Listening/Speaking evening Summer. PERSONAL INFORMATION: / / / / / / Application continued Tutorium in Intensive English I-20 APPLICATION INSTRUCTIONS: (for F-1 student visa) To obtain an I-20 form you need to submit the following. the Tutorium. Local contact Other: I do hereby declare that I am willing and able to financially maintain and support: Name of student: During his/her period of study at the Tutorium in Intensive