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English As A Second Language Institute Application

Please fill out the requested information below. Do NOT print this page. After completing this form, hit submit below. You will receive and email confirmation. All fields marked with an * are required.

Student Information

*Student Name (as stated on passport, resident alien card or other immigration document)
:   :



(5/6-8/1)
(9/3-11/27)
(1/13-4/11)
(5/5-8/1)
(9/2-11/25)


*Date of Birth




*Do you want your acceptance packet mailed to:

      OR


*Telephone Numbers

(or same as above)

*Visa Information


I am already in the US and have a visa. :


*Mark completion level

F-1 students, complete the following information if you have family members requiring an F-2 status:


  1. :


  2. :


  3. :

Required Admission Documents:

  • Official transcript (with English translation) from highest education level with proof of completion.
  • A non-refundable application fee of $100.00 USD. This will be applied to tuition upon acceptance. Make checks payable to UTChattanooga.
  • If resident alien or other immigration status, provide clear copy of immigration document (s).
  • F-1 applicants must provide a clear copy of current passport with photo page and expiration date showing. Include copies of family member’s passports if family will accompany you.
  • F-1 applicants must also submit official proof of funding to cover tuition and living expenses.
  • F-1 applicants who are currently in the US, submit copies of your current I-20, visa, passport, and I-94 card. A good standing statement from your school international advisor is required also.
  • Signed signature form.
  • Mail all completed application documents to:
  • Nancy Amberson
    International Student Advisor
    The University of Tennessee at Chattanooga
    Dept. 4755, 648 Oak Street
    Race Hall, 206
    Chattanooga, TN 37403

Student Cost Estimate for 1, Twelve Week Term:

Tuition (non-refundable) $2,400.00
F-1 student Mandatory Health Insurance $500.00
Living Expenses (approximate cost for housing, food, etc.) $3,000.00
Study Materials (approximate cost for books, etc.) $150.00
TOTAL

$6050.00

F-1 Students: For each additional dependent add $2,000

(Requesting an I-20 for more than one term requires submission of proof of funding for more than one term.)
On-Campus Housing: Contact Student Housing at (423) 425-4304 or visit the web site at www.utc.edu/Administration/StudentHousing/

Statement of Financial Responsibility

US citizens/residents are not required to provide financial information. All others must provide information below:

*How will I pay for the study at the English as a Second Language Institute?


**I understand that costs for study and living expenses at the ELI are approximately $5,900.00 for each 12-week term. I accept full responsibility for these expenses.

This application cannot be processed until all items are received.

Jane Womack, Director
(423)364-5591
Jane-Womack@utc.edu