Application Form

Please complete this entire application, which will go to our office. We will keep the information until we receive all required items: $50 application fee, financial statements, and school transcripts (proving that you have completed high school). Our address appears at the end of this application.

If you have questions you can e-mail us at any time (esl@newpaltz.edu). We will not process any application until all the items we require are received.

I plan to begin in the following term

Spring 2010 (January - May 2010)
Summer 2010 (3 weeks June)
Summer 2010 (7 weeks July - Aug 2010)
Fall 2010 (August - December 2010)

Enter your name as it appears on your passport

Family Name
Given Name

Contact information

Address in your home country

Street
City
State/Province
Country
Code

Telephone (include country code, city code, and number)
Fax (include country code, city code, and number)
E-mail address

Personal information

Date of Birth	Month	Day	Year
City of Birth
Country of Birth
Gender	Female Male
Country of Citizenship
If you are already in the U.S., what is your immigration status?
Please enter your immigration status
Are you transferring from another school in the U.S.?	Yes No
Please enter the name of the school in the U.S. that you are transferring from
Are you a high school graduate?	Yes No
Will you need to live on campus? (You must be at least 17 years of age to live on campus.)	Yes No

Address for you or a contact person in the U.S., if any

Family Name
Given Name
Street
City
State
Zip
Telephone
Fax

How did you learn about HELP?

	Friend/Relative	Name
	Agency	Name
	Advertisement	Publication
	Fair	City

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SUNY New Paltz - Haggerty English Language Program: Professional Apply Now