Application Form Summer 2012 IEP by HC120727071521

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									     Southern Methodist University Summer 2012
     ESL Intensive English Program (IEP)
                                      Application Form
 Fax, mail, or e-mail completed and signed form(s) and send $50.00 application fee* to:
                       John E. Wheeler, Director, ESL Program
                Office of General Education, Southern Methodist University
                          3200 Dyer St., Clements Hall, Room G02
                                      PO Box 750283
                                Dallas, Texas 75275-0283
                                   Fax: (214) 768-2511
                                    jwheeler@smu.edu


SECTION I – PERSONAL INFORMATION
1. Name:
As appears on passport – FAMILY NAME/SURNAME ,            FIRST NAME                 MIDDLE NAME
2.  Male  Female
3. Date of birth (month/date/year):
4. City of birth, country of birth:
5. Country of citizenship:
6. Passport number (INCLUDE A COPY OF YOUR MAIN PASSPORT PAGE):
7. Complete STREET address outside the U.S.:
   Should we use this address to ship your I-20 to you?  Yes  No




   International country code + telephone no.:                                    Fax:
8. Complete STREET address inside the U.S. (if not available, please give local contact):




   U.S. area code + telephone no.:                                                Fax:
9. E-mail address(es):

*Note: If you check letter A., B., or C. under Section II - Current Status below, you are not required to
pay the application fee. However, if you check letter D., you must submit a non-refundable fee of $50.00
U.S. before your application will be processed. Checks or money orders should be made payable to
"Southern Methodist University"; credit cards/wire transfers cannot be accepted for application fees!
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SECTION II – CURRENT STATUS
Check the box next to the ONE statement below that describes your current status:
 A. I am CURRENTLY ENROLLED AS A FULL-TIME STUDENT AT SMU in the
   _____________________ School with a major in ___________________________________
   (if declared) at the Graduate/Undergraduate (circle one) level.
 B. I have been offered CONDITIONAL ACCEPTANCE to SMU by the
   ________________________ School with a major in _____________________________ (if
   declared) at the Graduate/Undergraduate (circle one) level based on my successful
   completion of IEP study.
 C. I have been offered FULL AND UNCONDITIONAL ACCEPTANCE to SMU by the
   _______________________ School with a major in _________________________ (if
   declared) at the Graduate/Undergraduate (circle one) level.
 D. I am neither currently enrolled in SMU nor have I been granted acceptance of any kind.


SECTION III – IMMIGRATION/RESIDENCE INFORMATION
Check the ONE box below that describes your current immigration/residence status:
 I am currently residing in the U.S. with a/n:
                                                            (Give visa type, e.g. B, F, J, H, etc., if applicable)
F-1 visa students – I am transferring from:                                              (institution)*
 I am not currently residing in the U.S. and this will be my first time to visit the U.S.
 I am not currently residing in the U.S. but this will not be my first time to visit the U.S.
(List dates and purpose of any previous stays in the U.S. and type of visa you had):
* NOTE: Students transferring from another program in the U.S. must have received
conditional admission from a school of SMU before they can be accepted into the IEP!

Please list all other persons besides yourself who are requesting a visa (please add additional
dependents on a separate page). Only a spouse or child under age 21 may accompany you.
Please include copies of main passport pages and proof of relationship to you:
1.
     Full name as appears on passport   - Country of Birth - Citizenship - Date of birth (M/D/Y) - Relationship - Gender

2.
     Full name as appears on passport   - Country of Birth - Citizenship - Date of birth (M/D/Y) - Relationship - Gender



SECTION IV – EDUCATION AND ENGLISH LANGUAGE PROFICIENCY
This section is designed to help us anticipate your particular skills abilities in English before you
enter the IEP; this is not a test or exam. Before the first day of class, you will be given an English
Language Proficiency Test which will be used to place you in the level best suited to your needs.

Please note that producing an official TOEFL or other test score result is NOT a requirement
for acceptance; however, it will help us better assess your English language proficiency in
advance of your arrival.
1. Highest university degree earned (if any) and from which university:

2. Number of years you have studied English formally, and where:

rev. 3/12/12 JEW
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3. If available, give your most recent TOEFL score with date, specifying paper, computer, or
Internet-based:

4. If you have taken any comparable tests (e.g. TOEIC, IELTS) please give test score and date:


5. Rate your current English language abilities according to the following criteria by putting a
check () in the appropriate blanks below. The assessment you give will be validated against the
results of the English Language Proficiency Test you will take upon your arrival at SMU, so
please be as objective as possible.

                                          Excellent      Good       Average       Poor
          Speaking fluency
          Pronunciation
          Listening
          Reading
          Writing
          Grammar
          Vocabulary
          Knowledge of U.S. culture

6. What are your goals in attending the SMU IEP? Which English skills are you interested in
developing? Are you preparing for future university study?




SECTION V – COSTS AND ESTIMATED EXPENSES
Check the appropriate boxes below to calculate your total costs:
 Application fee (only for Current Status “D” students) – $50.00
 Summer tuition/fees (includes all books and materials) 6/27/12 to 8/10/12– $1,550.00
If you are also interested in applying for the next academic year, please indicate the terms below:
 Fall 2012 Term (12 weeks, 9/12/12 to 12/7/12) – $2,980.00
 Spring 2013 Term (12 weeks, 1/16/13 to 4/19/13, with one-week spring break) – $2,980.00

SMU Health Insurance – Required for students with an SMU student visa unless comparable
insurance is provided by your government. Please note that payment for SMU Health
Insurance is made separately from other IEP costs (details provided at registration).
 Summer Term Health Insurance (6 weeks, 6/27/12 to 8/10/12) – $182.00
Information on Fall 2012 and Spring 2013 Term Health Insurance yet to be announced.

On-Campus Summer Housing and Meals (check-in Tuesday, June 26, check-out Friday,
August 10; community bath, all bed and bath linens provided and changed weekly; housing
package includes three meals per day every day, starting with breakfast on June 26 and ending
with dinner on August 10. The student is responsible for payment of all costs related to any
housing/meals requests not cancelled before Monday, June 11!):
 Double Room Occupancy including Full Meal Plan – $2,480.00
rev. 3/12/12 JEW
                                                            4



Estimated living/incidental expenses for period of application: (estimated to be
approximately $12,000 per calendar year or $1000 per month) $ ___________

ENTER TOTAL COSTS AND ESTIMATED EXPENSES HERE: $ ______________


SECTION VI – ACCEPTANCE/PAYMENT POLICY* AND VERIFICATION
          Applicants with Current Status “A,” “B,” or “C” as described in Section II above are given
priority enrollment upon receipt of this Application Form (no application fee required). Students who
require an F-1 student visa must also complete and return the “Certificate of Financial Responsibility”
and carefully read the “Maintaining Your F-1 Status” information sheet included in this application
package. As soon as all necessary forms and documentation are received and have been processed, an e-
mail acknowledgement of acceptance letter containing further information will be sent to the applicant.
The student must pay all costs in full as calculated in Section V above during the on-campus
registration/orientation period.
          Applicants with Current Status “D” as described in Section II above who require an F-1 student
visa must complete and return this Application Form, the “Certificate of Financial Responsibility,” and
should carefully read the “Maintaining Your F-1 Status” information sheet included in this application
package. As soon as the complete application package has been received and processed, an e-mail
acknowledgement of acceptance letter containing further information will be sent to the applicant. The
student must pay all costs in full as calculated in Section V above during the on-campus
registration/orientation period.

*Methods of payment for tuition and housing/meals include credit card (including 2.75%
convenience fee) and bank wire transfers. We also accept personal checks from U.S. banks,
travelers checks, and international/U.S. money orders or cashiers’ checks. Any check should
be made payable to “Southern Methodist University”(NOT to IEP or John Wheeler)!


NOTE: AN I-901 FORM INCLUDED WITH NEW I-20/DS-2019'S MUST BE FILED ALONG
WITH THE APPROPRIATE FEE BEFORE YOU CAN RECEIVE YOUR VISA! DO NOT SEND
THE FORM TO THE SMU IEP; PLEASE USE THE ADDRESS PROVIDED ON THE PAPER
FORM OR YOU CAN SUBMIT THE FORM AND FEE ONLINE.



“I certify that the information I have provided in this application is complete and accurate, and I
accept all terms and conditions stated therein.”

Signature of Applicant: ______________________________________

Date of Application: ______________________________________


      Southern Methodist University will not discriminate in any employment practice, education program, or
       educational activity on the basis of race, color, religion, national origin, sex, age, disability, or veteran
        status. SMU’s commitment to equal opportunity includes nondiscrimination on the basis of sexual
       orientation. The Director of Affirmative Action has been designated to handle inquiries regarding the
      nondiscrimination policies and may be contacted at Southern Methodist University, Dallas, TX 75275.




rev. 3/12/12 JEW
     Southern Methodist University Summer 2012
     ESL Intensive English Program (IEP)
                 Certificate of Financial Responsibility
                  (Required only of those applicants requesting an F-1 visa)

The Certificate of Financial Responsibility is required for declaring and certifying your financial resources
for study at the SMU Intensive English Program and must be on file before we can issue you an I-20 form
used to obtain your F-1 visa. The certificate must be signed by your parent or sponsor (if any), and by you,
the student. Please complete this certificate and return it to our office with any attachments (i.e., separate
bank letters or scholarship letters from sponsors).

You should calculate your total expected costs and expenses as detailed under Section V of the
Application Form above, including what you think you might incur for incidental and living expenses
(housing, meals, miscellaneous, entertainment, etc.) for the period of time for which you are applying.
Living costs and incidental expenses for SMU students for one full calendar year are estimated to be
approximately $12,000 ($1000 per month). The U.S. Embassy or Consulate and/or U.S. Immigration
authorities may also require you to show evidence of financial support during your interview. If you are
sponsored by an agency such as your government, please also attach an official copy of their letter of
financial support. Total funding can be in a combination of several bank accounts, and supporting
documents are necessary from each bank account and sponsor (for example, partial funding from your
uncle and partial funding from your father would require bank statements and sponsor statements from both
your uncle and father).

If you are being sponsored by an individual, this form must be signed by both you and the sponsor.
Even though bank documents may be faxed in order to save time, seals and signatures must be in original
ink (not scanned or photocopied) and originals must be mailed to the address above. Monthly bank
statements or deposit slips copied on plain paper are not acceptable forms of financial documentation! In
the case that the student is being sponsored in whole or in part by an American resident currently
living in the United States, the sponsor must attach an I-134 Form (Affidavit of Support) with the
IEP application package; the form can be downloaded at http://www.uscis.gov/files/form/i-134.pdf.

SOURCE OF FUNDS IN U.S. DOLLARS:
Please check the boxes below as appropriate, and enter the amount of funds for each source in
the blanks that follow.
 Student's personal funds: $ ____________

 Family's funds outside the U.S.: $ ____________
NAME AND ADDRESS:

 Family's funds inside the U.S.: $ ____________
NAME AND ADDRESS:

 Other sponsor or government agency: $ ____________
NAME AND ADDRESS:


ENTER TOTAL OF ALL FUNDS LISTED ABOVE: $ ____________
(Total of all available funds listed above must be equal to or greater than TOTAL COSTS AND
ESTIMATED EXPENSES as calculated in Section V of the Application Form.)
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SPONSOR'S STATEMENT*
Name of Sponsor or Parent (please print):

(FAMILY) NAME/SURNAME,                           FIRST NAME                                MIDDLE NAME


I certify that I have read the information provided by the Student, that it is true and correct, and
that I will provide the funds to the student listed under TOTAL COSTS AND ESTIMATED
EXPENSES as calculated in Section V of the Application Form.
Signature:                                                        Date:




*IMPORTANT NOTE: If the student is being sponsored by an American resident currently living in the
United States, the sponsor must attach an I-134 Form (Affidavit of Support) with the IEP application
package; the form can be downloaded at http://www.uscis.gov/files/form/i-134.pdf.




STUDENT’S STATEMENT
Name of Student (please print):

(FAMILY) NAME/SURNAME,                           FIRST NAME                                MIDDLE NAME


I certify that the funds designated above are, in fact, available to me, and the information
provided is complete and true.
Signature:                                                        Date:




SEPARATE BANK DOCUMENT INFORMATION
An original bank letter must be included with the application package. The bank letter must:

1. Be current--within the past six months.
2. State the amount of funds available to the student in local currency and/or in U.S. Dollars at
the current exchange rate. If the bank does not want to show all of the funds available to the
individual, the statement can show that the parent/sponsor has at least the amount listed under
TOTAL COSTS AND ESTIMATED EXPENSES as calculated in Section V of the Application
Form.
3. Be on official and original bank stationery.
4. Be signed by a bank official.
5. Include the official bank stamp or be notarized.


See examples that follow on the next page:


rev. 3/12/12 JEW
                                                     3




SAMPLE 1

This is to certify that______________________________________ (family member or sponsor),
whose signature appears on the sponsor's statement, has the minimum funds of ______________
(local currency) equivalent to $ _________________ (must equal at least the minimum amount
in U.S. Dollars listed under TOTAL COSTS AND ESTIMATED EXPENSES as calculated in
Section V of the Application Form) to meet the total expenses of
___________________________________ (Student's Name) for the designated term of the SMU
Intensive English Program. This certification does not in any way constitute a statement of
liability on my part or that of the company or bank I represent.


SAMPLE 2
This is to confirm that __________________________________________________________ ,
sponsor of __________________________________________________ (student), has funds on
balance with our institution in the amount of _____________________________ (local currency)
equivalent to $ __________________ in U.S. Dollars. These funds are available with no
restrictions. We also wish to state that ____________________________________________
has been a client in good standing for a number of years.

This letter is issued without liability on the part of this institution or any of its officers.


SAMPLE 3
At the request of our client, ______________________________________________________ ,
we wish to confirm that he/she has maintained account relationships with this institution since
________ (year). The account has always been managed in a satisfactory manner and presently
shows more than ________________________________________ (local currency) equivalent to
$ ______________________ in U.S. Dollars (list at least the amount in U.S. Dollars indicated
under TOTAL COSTS AND ESTIMATED EXPENSES as calculated in Section V of the
Application Form), which is available with no restrictions to cover all tuition and expenses
incurred by the Student, _______________________________________ , during his/her studies
at your institution.

Bank Name:
                                                                                  STAMP OR
                                                                                  STAMP OR
Bank Address:


                                                                                    SEAL OF
                                                                                    SEAL OF
Bank Official's Name and Title:


Bank Official's Signature:                                                       BANK HERE
                                                                                 BANK HERE
Date:




rev. 3/12/12 JEW
     Southern Methodist University Summer 2012
     ESL Intensive English Program (IEP)
        Maintaining Your F-1 Status Information Sheet
Obtaining a visa/I-20 with a specific expiration date is not an assurance that you will be able to stay in the
US and maintain your student visa status. Your right to stay in the US may be taken away at any time if
you violate any of the following regulations. NOTE: “DHS” refers to the previously named INS.

 You must maintain a valid passport at all times:
  * PLEASE ATTACH TO THIS APPLICATION A COPY OF THE PAGE FROM YOUR
    PASSPORT WHICH CONTAINS YOUR PICTURE AND FULL NAME!
  * Apply for renewal at least 6 months before the expiration date.
  * Keep copies of passport, visa, I-94 and I-20 with you at all times.
  * Any time you travel outside Dallas, keep these original documents with you.

 You must receive written authorization to make changes to your I-20 in order to:
  * attend another school or university
  * transfer to another school or university
  * change your degree level or major field of study

 You must complete a full course of study for each term of the IEP. This is 20 classroom
  hours per week for IEP students.

 You must obtain permission from the DHS or the SMU International Center before accepting any
  kind of employment in the U.S., including both on- and off-campus. Even one day of work
  outside DHS guidelines will result in loss of status. On-campus work is limited to 20 hours when
  classes are in session. You must get work authorization every time you add or change your place
  of work. If you do not have work authorization IN WRITING, you do not have work
  authorization.

 You must allow a minimum of three days to obtain a new signature on your I-20 BEFORE
  traveling out of the US.

 To be in legal status, you must complete your course of study on or before the completion
  date in section 5 of your I-20. To request permission to extend this date, you must apply to
  the IEP Director one month before the program completion date!

 Report any changes of local or home country address, phone number, or e-mail address to the
  IEP Director and update such changes in Access.smu.edu within 10 days of the change.
  Failure to make such notification is a violation of DHS regulations. Students subject to
  the “Special Registration” must also report any such changes by submitting an AR-11SR
  form to the address listed on that form, also within 10 days of any change.

 You must maintain contact with both the IEP Director and the SMU International Center by
  regularly checking all e-mail correspondence. Failure to check e-mail at least several times
  per week may have serious consequences!
                                                   2


 You must maintain continual health insurance coverage for yourself and any dependents in
  the U.S. You must have a copy of your current health insurance card on file in the
  International Center at all times!

               Health insurance must:
               * pay for at least $50,000 per accident or illness;
               * not have a deductible which exceeds $500 per accident or illness;
               * cover repatriation for $7,500;
               * cover medical evacuation for $10,000.

 You must obey all U.S. federal and Texas state laws.

 You must leave the U.S. when:
  * your I-20 expires OR
  * you graduate OR
  * you have ended or suspended your SMU program as a student.

     *Even if your I-20 is still valid, you must leave the U.S. if you are no longer enrolled in your
     program for any reason. You may consult the International Center to discuss exceptions to
     this requirement such as extending your program or transferring to a new program.

 You must meet with an International advisor for an exit interview one month before your
  final day of class.

 If you are subject to Special Registration, you are responsible for maintaining all Special
  Registration records and reporting.

 It is strongly recommended that you complete one full term of the IEP before requesting a
  transfer to another school or institution.

 You must fill out the form 8843 to the IRS every year even if you did not earn any wages. If
  you have earned wages, you must also submit the form 1040NR or 1040NR-EZ.

 New students must attend the mandatory IEP orientation session held at the beginning of the
  course of study.




“As an F-1 visa student of SMU’s IEP, I understand that SMU is required
 by law to terminate my F-1 student visa status and academic program if I
             violate any of the above compliance requirements.”




rev. 3/14/10 JEW

								
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