Exit without saving >> LCI@RU Intensive English Program Application Application Question Title * 1. Name EXACTLY AS IT APPEARS ON YOUR PASSPORT: First Name(s) Family Name Question Title * 2. Email Address: Primary email address Alternate email address Question Title * 3. Country of Birth AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA ASHMORE AND CARTIER ISLANDS AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS, THE BAHRAIN BAKER ISLAND BANGLADESH BARBADOS BASSAS DA INDIA BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRITISH VIRGIN ISLANDS BRUNEI BULGARIA BURKINA FASO BURMA BURUNDI CAMBODIA CAMEROON CANADA CANAL ZONE CANTON AND ENDERBURY CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CENTRAL AND SOUTHERN LINE ISLANDS CHAD CHILE CHINA CHRISTMAS ISLAND CLIPPERTON ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, DEMOCRATIC REPUBLIC OF THE COOK ISLANDS CORAL SEA ISLANDS COSTA RICA COTE D IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC CZECHOSLOVAKIA DEMOCRATIC REPUBLIC OF VIET-NAM DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA EUROPA ISLAND FALKLAND ISLANDS (ISLAS MALVINAS) FAROE ISLANDS FEDERAL REPUBLIC OF GERMANY FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN AND ANTARCTIC LANDS FRENCH TERRITORY OF THE AFARS AND ISSAS GABON GAMBIA, THE GAZA STRIP GEORGIA GERMAN DEMOCRATIC REPUBLIC GERMANY GERMANY, BERLIN GHANA GIBRALTAR GILBERT AND ELLICE ISLANDS GILBERT ISLANDS GLORIOSO ISLANDS GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD SLANDS HONDURAS HONG KONG HOWLAND ISLAND HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRAQ-SAUDI ARABIA NEUTRAL ZONE IRELAND ISLE OF MAN ISRAEL ISRAEL-JORDAN DEMILITARIZED ZONE ISRAEL-SYRIA DEMILITARIZED ZONE ITALY JAMAICA JAN MAYEN JAPAN JARVIS ISLAND JERSEY JOHNSTON ATOLL JORDAN JUAN DE NOVA ISLAND KAZAKHSTAN KENYA KINGMAN REEF KIRIBATI KOSOVO KUWAIT KYRGYZSTAN LAOS 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 MIDWAY ISLANDS MOLDOVA MONACO MONGOLIA MONTENEGRO MONTENEGRO (prior to 2001) MONTSERRAT MOROCCO MOZAMBIQUE NAMIBIA NAURU NAVASSA ISLAND NEPAL NETHERLANDS NETHERLANDS ANTILLES NEUTRAL ZONE NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTH KOREA NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALMYRA ATOLL PANAMA PAPUA NEW GUINEA PARACEL ISLANDS PARAGUAY PERU PHILIPPINES PITCAIRN ISLANDS POLAND PORTUGAL PORTUGUESE TIMOR PUERTO RICO QATAR REPUBLIC OF VIET-NAM REUNION ROMANIA RUSSIA RWANDA SAINT BARTHELEMY SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT MARTIN SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SERBIA (prior to 2001) SERBIA AND MONTENEGRO SEYCHELLES SIERRA LEONE SIKKIM SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SOUTH KOREA SOUTHERN RHODESIA SOUTHERN RYUKYU ISLANDS SPAIN SPANISH NORTH AFRICA SPANISH SAHARA SPRATLY ISLANDS SRI LANKA STATELESS SUDAN SURINAME SVALBARD SVALBARD AND JAN MAYEN SWAN ISLANDS SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA THAILAND TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TROMELIN ISLAND TRUST TERRITORY OF THE PACIFIC ISLANDS TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNION OF SOVIET SOCIALIST REPUBLICS UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES UNITED STATES MISC. PACIFIC ISLANDS UNKNOWN URUGUAY UZBEKISTAN VANUATU VATICAN CITY VENEZUELA VIETNAM VIRGIN ISLANDS WAKE ATOLL WALLIS AND FUTUNA WEST BANK WESTERN SAHARA YEMAN (SANAA) YEMEN YEMEN (ADEN) YUGOSLAVIA ZAMBIA ZIMBABWE Question Title * 4. Country of Citizenship AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOLA ANGUILLA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA ASHMORE AND CARTIER ISLANDS AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS, THE BAHRAIN BANGLADESH BARBADOS BASSAS DA INDIA BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRITISH VIRGIN ISLANDS BRUNEI BULGARIA BURKINA FASO BURMA BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND CLIPPERTON ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, DEMOCRATIC REPUBLIC OF THE COOK ISLANDS CORAL SEA ISLANDS COSTA RICA COTE D IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA EUROPA ISLAND FALKLAND ISLANDS (ISLAS MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN AND ANTARCTIC LANDS GABON GAMBIA, THE GAZA STRIP GEORGIA GERMANY GHANA GIBRALTAR GLORIOSO ISLANDS GREECE GREENLAND GRENADA GUADELOUPE GUATEMALA GUERNSEY GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD SLANDS HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISLE OF MAN ISRAEL ITALY JAMAICA JAN MAYEN JAPAN JERSEY JORDAN JUAN DE NOVA ISLAND KAZAKHSTAN KENYA KIRIBATI KOSOVO KUWAIT KYRGYZSTAN LAOS 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 NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEUTRAL ZONE NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTH KOREA NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARACEL ISLANDS PARAGUAY PERU PHILIPPINES PITCAIRN ISLANDS POLAND PORTUGAL QATAR REUNION ROMANIA RUSSIA RWANDA SAINT BARTHELEMY SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT MARTIN SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SOUTH KOREA SPAIN SPRATLY ISLANDS SRI LANKA STATELESS SUDAN SURINAME SVALBARD SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA THAILAND TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TROMELIN ISLAND TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNKNOWN URUGUAY UNITED STATES UZBEKISTAN VANUATU VATICAN CITY VENEZUELA VIETNAM WALLIS AND FUTUNA WEST BANK WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE Question Title * 5. Gender: Male Female Question Title * 6. Date of Birth: Month Day Year Age requirement 17 or older Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Age requirement 17 or older Month menu 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Age requirement 17 or older Day menu 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Age requirement 17 or older Year menu Question Title * 7. Permanent address (the address where you live): Street City State/Province ZIP/Postal Code Country Telephone Fax Question Title * 8. Address where we will send your I-20: (overseas applicants only, if different from permanent address) Recipient Name Street City State/Province Postal Code Country Telephone Fax Question Title * 9. Contact relative or friend in the U.S. (if any): Contact Name Telephone Email .................................................................................................................................................................................................................... Question Title * 10. Choose the term you plan to BEGIN study: Spring II: March 14, 2016 - May 13, 2016 Summer I: May 23, 2016 - July 1, 2016 Summer II: July 5, 2016 - Aug. 13, 2016 Fall I: Aug. 22, 2016 - Oct. 14, 2016 Fall II: Oct. 17, 2016 - Dec. 16, 2016 Spring I: Jan. 16, 2017 - March 10, 2017 Question Title * 11. How many terms do you plan to study? One term Two terms (one semester) Three terms Four terms (two semesters) Five terms Six terms (one year) .................................................................................................................................................................................................................... Question Title * 12. First-term housing preference: Staying with family or friends Homestay in an area home Residence on campus (Main Campus ONLY, subject to availability & summer only) Apartment (recommended for family) Question Title * 13. How did you find out about the Intensive English Program? A friend or relative at Virginia Tech A friend or relative at Radford University Information at an educational fair An advertisement in a magazine On the AAIEP website Through an Internet search Through your company, a government office, an embassy or an educational agency (please provide contact name and email) Question Title * 14. Have you had English language training at other schools?(check all that apply) Elementary or secondary school International or American school School in an English-speaking country Private language institute Language institute in the U.S. No formal English language training Question Title * 15. Current immigration status: New Student Visa (F-1) Applicant Student Visa Transfer Business/Visitor Visa or Visa Waiver U.S. Citizen or Resident Alien Other (F-2, J-1, J-2, Refugee, etc.)/please specify .................................................................................................................................................................................................................... TELL US ABOUT YOUR PLANSIf you are planning to attend a college or university following your English language training, including Radford, please respond to questions 16-19. Question Title * 16. Why are you learning English as a second language? To attend a U.S. college or university For college or university in your own country For business or career purposes For pleasure Question Title * 17. What are your college or university plans? Graduate studies at Radford University Undergraduate studies at Radford University Graduate studies at another college or university Undergraduate studies at another college or university Community college Career or technical school Question Title * 18. If not Radford University, what school are you planning to attend? (if unsure, enter "undecided") Question Title * 19. What major do you wish to pursue?(examples: Bachelor of Science in Biology, Masters in Sociology, etc.) .................................................................................................................................................................................................................... F-1 TRANSFER DETAILSPlease complete the following section (questions 15-18) only if you are currently an F-1 student and will be transfering from another school. Question Title * 20. Name of the institution you are transfering from: Question Title * 21. Institution type: English Language Program Graduate Degree Program Four-Year College or University Community College Other (please specify) Question Title * 22. Transfer institution contact information: Advisor Name Title (if known) Email/Telephone Question Title * 23. U.S. address where we will send your transfer I-20: Street City State ZIP Code Country Telephone Fax Email .................................................................................................................................................................................................................... NEW STUDENT VISA APPLICANTS AND F-1 TRANSFERSPlease complete the following section (questions 19-24) if your spouse and/or children will accompany you to the United States. Question Title * 24. Spouse: Full Name Sex (male/female) Birth Date (mm/dd/yyyy) Country of Birth Country of Citizenship Question Title * 25. Dependent child #1: Full Name Sex (male/female) Birth Date (mm/dd/yyyy) Country of Birth Country of Citizenship Question Title * 26. Dependent child #2: Full Name Sex (male/female) Birth Date (mm/dd/yyyy) Country of Birth Country of Citizenship Question Title * 27. Dependent child #3: Full Name Sex (male/female) Birth Date (mm/dd/yyyy) Country of Birth Country of Citizenship Question Title * 28. Dependent child #4: Full Name Sex (male/female) Birth Date (mm/dd/yyyy) Country of Birth Country of Citizenship Question Title * 29. Dependent child #5: Full Name Sex (male/female) Birth Date (mm/dd/yyyy) Country of Birth Country of Citizenship Next >>