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ELA/ESL Program Online Registration Form

Use a separate form for each person or program.
Complete and submit the online registration form.
Once your application has been received, you will receive a confirmation email.
Registration is not guaranteed and an I-20 will not be issued until full payment is received.
Acceptance into the ELA program does not allow you to take traditional university courses. The ELA has a fixed curriculum. You will not be permitted to take additional university credit coursework. Upon completion of this program, you may apply for official enrollment into the University of Wisconsin-Eau Claire through the Office of Admissions if you have met all the University entrance requirements and have appropriate documentation from your home country.
If you are denied a visa, a full refund will be given.

* I would like to register for (select from listing below):

	Summer Session (July 5 - August 3, 2008 4 weeks) - $2995.00 USD
	Fall Semester English as a Second Language Program (September - December, 16 weeks) - $7,345.00 USD
	Spring Semester English as a Second Language Program (January - May, 16 weeks) - $7,345.00 USD

* Family Name/Surname:: (as printed on passport):
* First Name/Given Name: (as printed on passport):
* Middle Name or Initial: (as printed on passport):
* Permanent Mailing Address: (number and street):
* Town or City:
* Province or State:
* Country:
* Postal Code:
* Gender:	Male	Female
*Date of Birth (month/day/year):
*Birth Country:
* Country of Citizenship:
* Passport Number:
* Issuing Country:
* Date of Issue(month/day/year):
* Email address:
*Phone Number:

Education Background:
(Please note: Two years of English language instruction and a high school diploma or it's equivalent are required for this program.)

List in chronological order your educational history, starting with high school.
This information must be filled out to be accepted into the program. If non-applicable please place the letter "Z" in the area where information is requested.

* Name of School:
* Degree Earned:
* Date Earned:

* Name of School:
* Degree Earned:
* Date Earned:

* Name of School:
* Degree Earned:
* Date Earned:

Please rate your present knowledge of English:

* Speaking	good fair poor none
* Understanding	good fair poor none
* Reading	good fair poor none
* Writing	good fair poor none

Number of years you have studied English:
If non-applicable please place the letter "Z" in the area where information is requested

* in a secondary school
* in a university

* Required fields

It is our policy not to share, sell or distribute the contents of our mailing lists or e-mail lists to organizations outside of the University of Wisconsin-Eau Claire.

How did you hear about this program?

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