University at Albany – State University of New York Intensive English Language Program Application Form Please carefully fill out the following information. We will use this information to create your University at Albany and SEVIS records. Be sure that all information is accurate and that all statements are true. * Required * Please verify the 8-week session you want to apply for. . I am applying for the following session: * FAMILY NAME exactly as it appears on your passport: * GIVEN NAME exactly as it appears on your passport: MIDDLE NAME exactly as it appears on your passport: * PERMANENT ADDRESS in your country. (This must be the home address of the student.) PHONE NUMBER (Including country code): * EMAIL ADDRESS: AGENT ADDRESS (if applicable): AGENT PHONE NUMBER: AGENT EMAIL ADDRESS: * COUNTRY OF BIRTH: * COUNTRY OF CITIZENSHIP: * DATE OF BIRTH: * GENDER: Male Female * HIGHEST DEGREE COMPLETED: High School University (Undergraduate) University (Graduate) Other * Do you need an I-20 for an F-1 Student Visa? Yes No
University at Albany – State University of New York Intensive English Language Program Application Form Please carefully fill out the following information. We will use this information to create your University at Albany and SEVIS records. Be sure that all information is accurate and that all statements are true. * Required Please verify the 8-week session you want to apply for. . * I am applying for the following session: FAMILY NAME exactly as it appears on your passport: * GIVEN NAME exactly as it appears on your passport: * MIDDLE NAME exactly as it appears on your passport: PERMANENT ADDRESS in your country. (This must be the home address of the student.) * PHONE NUMBER (Including country code): EMAIL ADDRESS: * AGENT ADDRESS (if applicable): AGENT PHONE NUMBER: AGENT EMAIL ADDRESS: COUNTRY OF BIRTH: * COUNTRY OF CITIZENSHIP: * DATE OF BIRTH: * GENDER: * Male Female HIGHEST DEGREE COMPLETED: * High School University (Undergraduate) University (Graduate) Other Do you need an I-20 for an F-1 Student Visa? * Yes No