Application for Intensive English Program Identification I am applying for: Fall (August - December) Winter (January - April) Year: 2025 2026 2027 2028 First Name (as it appears on your passport) Last Name (as it appears on your passport) Middle Name Alternate Name Date of birth (MM/DD/YYYY) Country of birth United States of America Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Cote D Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Saint-Martin (France) Saint-Martin (Pays-Bas) Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe City of birth Country of citizenship United States of America Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Cote D Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Saint-Martin (France) Saint-Martin (Pays-Bas) Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Are you a U.S. citizen? Yes No Do you have a U.S. social security number? Yes No Home country telephone number Cellphone number Please write your permanent, home address in your home country Country United States of America Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Cote D Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Saint-Martin (France) Saint-Martin (Pays-Bas) Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe City Postal code Email Gender Male ♂ Female ♀ Non-Binary / Other Marital status Married Single If you are living in the U.S. now, please write your U.S. address here State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming City Zip code Telephone number in the U.S. (If you have one) Have you previously applied for admission to Eastern Michigan University? Yes No If yes, what is your EMU ID number? Have you taken a TOEFL or IELTS test? (not required for admission) TOEFL score (if available) IELTS score (if available) Do you need an I-20 to obtain a student visa? Yes No If you are now in the United States, check your current immigration status F-1 (Student) F-2 (Dependent) Other Resident Registration A#: Effective Date: Transfer Students Are you currently studying at another school in the United States? Yes No If Yes, Please provide the name and phone of the institution Institution name Institution phone Institution address Institution city Institution state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Institution zip code If you are a F/J visa holder, what is your SEVIS N number? Where did you learn about the English Program? Friend Advertisement (name of publication) Internet search or specific website Travel or Study Abroad Agency Educational fair Other If you are a transfer student, please also submit: Copy of your current visa: Copy of your current I-94: Copy of your current I-20: Educational Background List the last high school and all colleges/universities you have previously attended or attempted credit (list the most recent first).Most Recent College/UniversitySchool Name City/State/Zip Date Enrolled Graduation Date Most Recent High SchoolSchool Name City/State/Zip Date Enrolled Graduation Date Financial Statement of Responsibility If you are bringing dependents, you must upload a copy of the passport of each dependent and complete the information below: Last Name First Name Relationship to Applicant Date of Birth City of Birth Country of Birth Country of Citizenship Please upload a copy of the passport for each dependent. First dependent's passport Second dependent's passport Third dependent's passport Fourth dependent's passport Fifth dependent's passport Estimated Costs Estimated costs include tuition and fees, transportation, books, room and board and mandatory health insurance. Costs are for one academic year rates. Amounts are shown in United States Dollars (USD) for minimum full-time enrollment. Please complete the cost estimate below. Spouse Yes no Children Total USD for I-20 Eligibility Estimates Tuition and Fees $15,920 Living expenses $16,580 Health Insurance $2,145 Living expenses for each family member $6,325 Please upload the supporting documents. Copy of your passport: Financial Affidavit: International applicants must submit an official bank statement or scholarship statement with original/live signatures providing proof of liquid funds equal to or exceeding the "Total USD for I-20 Eligibility" above. The bank statement can be emailed to the address below. If the name on the bank statement is NOT the applicant, please have the sponsor fill out the Financial Affidavit of Support. Email address for all financial documents: esl@emich.edu Note for SACM students: all financial guarantees must be submitted in one of the following ways: a PDF file form a SACM advisor, an email form a SACM advisor, or and original delivered in person or by mail. Email copies from applicants and fax copies cannot be accepted. Applicant's Statement Eastern Michigan University’s Intensive English Program application includes the following questions regarding prior criminal convictions and/or disciplinary history, and the information provided by the student may be considered when making the decision as to whether to admit the student to the Intensive English Program. Question: Have you ever been convicted of a criminal offense other than a minor traffic violation, or found to be delinquent by a juvenile court, or are there any such charges currently pending against you at this time? Yes No If you answer yes, please write an explanation. Question: Have you ever been expelled, suspended, placed on probation, or been subject to any other disciplinary action at any secondary school or college you have attended? Yes No If you answer yes, please write an explanation. Eastern Michigan University adheres to the principle of equal education and employment opportunity, and programs and activities of the University are open to all qualified persons without regard to race, gender, sexual orientation, color, creed, national origin or disabling condition. This policy extends to all programs and activities supported by the University. Applicant’s statement: I certify that all information on all pages of this application is complete and accurate to the best of my knowledge, and that I have listed all institutions previously attended. I understand that misrepresentation or omission of any information may be cause for denial of or cancellation of admission or may result in my being suspended or dismissed from Eastern Michigan University, if discovered subsequent. I understand that all pertinent rules and policies of Eastern Michigan University apply to me immediately upon admission and that it is my responsibility to become knowledgeable about them. I understand that all credentials submitted in support of this application become the property of the University and are not returnable. I agree my electronic signature is the legal equivalent of my manual signature on this document and I recognize that I am legally bound by the provided information. Type applicant surname/last name and first name. Date: March 25, 2025 Submit application for IEP Submit application for IEP