|
| Last*: |
|
Middle: |
|
First*: |
|
| Gender: |
|
Date of Birth: |
|
Email*: |
|
| Foreign
Address: |
| Street*: |
|
Apt. # |
|
| City, State, Postal Code*: |
|
Country: |
|
| Phone Number*:
| |
E-mail*: |
|
| U.S. Address: |
| Street: |
|
Apt. # |
|
| City: |
|
State: |
|
Zip: |
|
| Phone Number* : |
|
Mobile Number*: |
|
| Others: |
| Country of Birth: |
|
| Country of Citizenship: |
|
| Country of Residency: |
|
| |
| PART II -
Admissions Data |
| Choose a Campus: |
|
| Application Status for New York,San Francisco and New Jersey: |
|
| Specifications for preparing
and issuing your I-20 Form: |
| Please indicate the purpose of I-20 form
|
|
|
Please indicate the date on which you will
start your classes:
|
|
|
Note: The starting date must be on a Monday.
|
Have you previously
studied at CPLC? |
|
| How long are you going to study at CPLC?
|
|
| Do you want us to help you find accommodations ? |
|
Do you want us to arrange airport pick up?
If yes please write the name of the airport
|
|
| Sponsor
Information |
| Last Name: |
| First Name: |
|
MI: |
|
| Number and
Street:
|
|
City:
|
|
State:
|
|
| Zip:
|
|
| Country:
|
|
Phone Number: |
|
| E-mail Address: |
|
Relationship to the student: |
|
| |
| PART III - Visa
Requirement Data |
You must have a passport
valid for at least 6 months.
|
| Mail Service Request |
|
|
Yes, I would like my I-20 form to be sent to my home
address.
I understand that a mailing fee must be paid
before my documents can be sent.
|
No, please hold my I-20 form, which will be claimed by my
relative, representative or by me.
|
Are
you including your children and spouse as dependents (F-2
status holders)?
If yes, please
complete Part IV - Dependents Information section
otherwise skip to
Part V - Educational Data |
| |
| |
| PART IV-
Dependents Information Sheet |
| Dependent
1 |
| Last Name: |
|
First Name: |
|
MI: |
|
| Date of Birth: |
Sex:
|
| Nationality: |
|
Country of Birth:
|
| Relationship to the Student: |
|
| Dependent
2 |
Last Name:
|
|
First Name:
|
|
MI:
|
|
Date of Birth:
Sex:
|
Nationality:
Country of
Birth:
|
| Relationship to the
Student: |
|
| |
| PART V -
Educational Data |
Highest level of education completed:
|
|
| PART VI |
Where did you hear about us?
|
|
| Emergency
Contact |
Name *:
|
|
Address*: |
|
|
City: |
|
State:
|
|
Zip:
|
|
|
Country: |
|
Phone Number *:
|
Relationship to the
Student:
|
| |
| Note: |
Submitting this application does not
guarantee your admission to CPLC. All required documentation
has to be submitted along with this form.
|
Signature: |
I certify that the
information supplied on this application is complete and
correct to the best of my knowledge. I agree to abide by the
rules and regulations of the school as set forth in the CPLC Education Center's Student Catalog.
|
|
| |
|
| |