ULI | Application for ESL admission

This application should be mailed / faxed with your $100.00 non-refundable application fee to:

OFFICE OF ADMISSIONS
3130 Commerce Parkway Miramar, Florida 33025
Ph (954) 607- 4344 Fax (954) 357-1766
E-mail: admissions@unilatina.edu

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ESL APPLICATION FOR ADMISSION

This application has a $100 non-refundable fee. Once you submit this form, you will receive an e-mail with instructions to make your online payment.

Student Information

First Name

Middle Name

Last Name

Emaila valid email

Home Phone

Work Phone

Mobile Phone

Adress

City

State / Province / Region

Postal / Zip code

Date of Birth

Social Security:

International Students

Country of Origin’s Address:

City

State / Province / Region

Postal / Zip code

Country

Country of Birth

City of Birth

Country of Citizenship:

STATUS INFORMATIONpick one!

U.S. CitizenPermanent Resident: If you are a permanent resident, please provide your A# in the field marked "A#"International Student Other (please explain)

(please explain)

Education

High School Attended

City

Country

Graduation Year

College Attended

City

Country

Graduation Year

Employment

Are you currently employed?pick one!

YesNo

Name of Employer

Address

City

State

Zip Code

Phone Number

Schedule of Interest

I, the applicant, CERTIFY THAT the information given in this application is complete and accurate. I further understand that falsification or failure to supply the correct information may lead to the disqualification of my application to UNILATINA Language Institute. I certify that I am in good standing in all respects at my previously attended institution(s). I also accept full responsibility for any debts incurred.

Schedulepick one!

ESL Morning: M-TH 8:30 AM – 1 PM. (One day until 1:40 p.m.)ESL Evening: M-F 6:00 – 9:30 PM. (One day until 10:00 p.m., one day beginning at 5:40 pm)

Electronic Signature of Applicant

Referred to UNILATINA LANGUAGE INSTITUTE by

Date

Signature of parent or guardianrequired if applicant is under the age of 18

Date

Admissions Representative Signature Date

*Refundable within first 3 days after signing enrollment agreement or if enrolled prior to visiting the campus, within three days of scheduled orientation or a tour of the school and inspection offacilities and equipment.

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