‫‪Faulkner University-ELI‬‬

‫اىَدٍْت‪ٍ :‬وّتغَسً‬
‫اىوالٍت‪ :‬جوزجَب‬
‫اىعْواُ اإلىنتسوٌّ ‪https://ww2.faulkner.edu/secure/eli/ :‬‬

‫ٍالحظبث‪:‬‬
‫ قٌ بتعبئت اىَْوذج حسب اىَوضع فٌ اىَْوذج اىَسفق‪ٍ .‬ع اىتأمد بأُ بَبّبتل ٍطببقت ىجواش‬‫اىسفس‪.‬‬
‫ قٌ بإزسبه صوزة ٍِ جواشك و اىضَبُ اىَبىٌ بغسض اىقبوه إىي اإلٍََو اىتبىٌ‬‫‪ehicks@faulkner.edu‬‬
‫ قٌ بدفع زسوً اإلشتساك إٍب عِ طسٍق اىَوقع ٍببشسة‪ .‬تأمد أُ ىدٍل ٍبستس مبزد أو مسٍدث مبزد‬‫أو بطبقت ٍسبقت اىدفع و اىَتوفسة ىدى اىبْوك اىسعودٍت‪ .‬ىدفع زسوً األبينَشِ و اىرً ٍقدز‬
‫بـ ‪ 022‬دوالز أً ٍب ٍعبده ‪ 022‬زٍبه‬
‫ٍسجي ىيَزٍد ٍِ اىَعيوٍبث ٍساسيت أسسة سعودٍوُ فٌ أٍسٍنب ‪،،،‬‬

‫‪www.saudiusa.com‬‬

‫‪8/22/2012‬‬

‫‪Faulkner University-ELI‬‬

8/23/12

English Language Institute

Faulkner University

English Language Institute Application for Admission
Program Information

Spring
‫ﺇﺧﺘﺮ ﺍﻟﻔﺼﻞ ﺍﻟﺪﺭﺍﺳﻲ ﻟﻠﺒﺪﺀ ﻏﺎﻟﺒ ًﺎ‬
Se le ct A Te rm :
Se le ct Location:

Se le ct A Program :

Intensive English Program

Montgomery

‫ﻗﻢ ﺑﺈﺧﺘﻴﺎﺭ ﻫﺬﺍ ﺍﻟﺨﻴﺎﺭ‬

Personal Information
First Nam e :

Middle Nam e :

Last Nam e :

Pre fe rre d Nam e :

Date of Birth: (dd/mm/yyyy)

‫ﺍﺳﻢ ﺍﻷﺏ‬

‫ﺍﻻﺳﻢ ﺍﻷﻭﻝ‬

‫ﺍﻟﻠﻘﺐ‬

‫ ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ ﺍﻟﻴﻮﻡ ﺍﻟﺸﻬﺮ ﺍﻟﺴﻨﺔ‬Ge nde r:

C ountry of Birth:

Afghanistan

C ountry of C itize nship:

Afghanistan

Em ail:

Male

‫ﺍﻟﺠﻨﺲ‬

‫ﺩﻭﻟﺔ ﺍﻟﻤﻴﻼﺩ‬
‫ﺍﻟﺠﻨﺴﻴﺔ‬
C onfirm Em ail:

‫ﻛﺘﺎﺑﺔ ﺑﺮﻳﺪﻙ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ﻣﺮﺓ ﺃﺧﺮﻯ‬

‫ﺑﺮﻳﺪﻙ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
Education Information

‫ﺃﺧﺮ ﺷﻬﺎﺩﺓ ﺣﺼﻠﺖ ﻋﻠﻴﻬﺎ‬

‫ﺑﻜﺎﻟﺮﻳﻮﺱ‬
C olle ge
‫ﺍﻟﺜﺎﻧﻮﻳﺔ‬
‫ﺑﻌﺾ ﻣﻦ ﻣﻮﺍﺩ ﺍﻟﺠﺎﻣﻌﺔ‬
Are You a Transfe r Stude nt:
‫ﺃﻣﺮﻳﻜﻴﺔ؟‬
‫ ﺃﻧﺖ ﻣﺤﻮﻝ ﻣﻦ ﺟﺎﻣﻌﺔ‬No
‫ﻫﻞ‬
Le ve l of Education C om ple te d:
High School

Date of TO EFL:

Som e C olle ge

‫ﻣﺘﻰ ﺇﺧﺘﺒﺮﺕ ﺍﻟﺘﻮﻓﻞ‬

How Did You Tak e The TO EFL?

(dd/mm/yyyy)
Pape r

C om pute r

‫ﻣﺎ ﻫﻮ ﻧﻮﻉ ﺇﺧﺘﺒﺎﺭ ﺍﻟﺘﻮﻓﻞ ﺍﻟﺬﻱ ﺇﺧﺘﺒﺮﺗﻪ؟‬
‫ﺑﺈﻣﻜﺎﻧﻚ ﺗﺮﻙ ﻫﺬﻩ ﺍﻟﺤﻘﻮﻝ ﻓﺎﺭﻏﺔ‬
Religious Information
Your Pre fe re nce :

‫ﺇﺫﺍ ﺣﺼﻠﺖ ﻋﻠﻰ ﺷﻬﺎﺩﺓ ﺃﺧﺮﻯ‬

O the r If O the r, Ple ase List:

Have You Tak e n the TO EFL:

‫ﻫﻞ ﺇﺧﺘﺒﺮﺕ ﺍﻟﺘﻮﻓﻞ ﻣﻦ ﻗﺒﻞ؟‬

TO EFL Score :
Inte rne t

Fathe r's Pre fe re nce :

Continue

No

‫ﺩﺭﺟﺔ ﺍﻟﺘﻮﻓﻞ‬
n/a

Mothe r's Pre fe re nce :

Reset

© 2000 -2009 Faulk ne r Unive rsity
5345 Atlanta Highway, Montgom e ry, AL 36109 · 334.272.5820 or 800.879.9816 · Privacy / Le gal

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8/23/12

English Language Institute

Faulkner University

English Language Institute Application for Admission
A ddress to which the I20 should be sent

‫ﻗﻢ ﺑﺘﻌﺒﺌﺔ ﻫﺬﺍ ﺍﻟﺤﻘﻮﻝ ﻹﺭﺳﺎﻝ ﻧﻤﻮﺫﺝ ﺍﻟﻘﺒﻮﻝ ﻟﻌﻨﻮﺍﻥ ﻓﻲ ﺍﻟﺴﻌﻮﺩﻳﺔ‬

C ountry:

Afghanistan

State /Province :

Badakhshan Province

C ity:

‫ﺍﻟﻤﺪﻳﻨﺔ‬

Postal C ode :

‫ﺍﻟﺮﻣﺰ ﺍﻟﺒﺮﻳﺪﻱ‬

Stre e t:

‫ﺍﺳﻢ ﺍﻟﺸﺎﺭﻉ‬

Phone Num be r:

‫اﻟﺪوﻟﺔ‬
‫ﺍﻟﻤﻨﻄﻘﺔ‬

‫ﺭﻗﻢ ﻫﺎﺗﻔﻚ‬

Would you like to add another contact?

No

Continue

Reset

© 2000 -2009 Faulk ne r Unive rsity
5345 Atlanta Highway, Montgom e ry, AL 36109 · 334.272.5820 or 800.879.9816 · Privacy / Le gal

https://ww2.faulkner.edu/secure/eli/contact.cfm

1/1

8/23/12

English Language Institute

Faulkner University

English Language Institute Application for Admission

‫ﺇﻥ ﻛﻧﺕ ﺧﺭﻳﺞ ﺍﻟﺛﺎﻧﻭﻳﺔ ﺍﻟﻌﺎﻣﺔ ﻗﻡ ﺑﺗﻌﺑﺋﺔ ﻫﺫﺍ ﺍﻟﻧﻣﻭﺫﺝ‬
High School Information
High School Nam e :

askje kdan lkjsd

High School Graduation Date :
(mm/yyyy)

04/2005

‫ﺍﺳﻡ ﺍﻟﻣﺩﺭﺳﺔ‬
‫ ﺍﻟﺳﻧﺔ‬، ‫ ﺍﻟﺷﻬﺭ‬: ‫ﺗﺎﺭﻳﺦ ﺗﺧﺭﺟﻙ ﻣﻥ ﺍﻟﻣﺩﺭﺳﺔ‬
‫ﻣﻌﺩﻟﻙ ﻓﻲ ﺍﻟﺛﺎﻧﻭﻳﺔ ﺍﻟﻌﺎﻣﺔ‬

High School GPA:

High School C ountry:

Saudi Arabia

High School State /Province :

Makkah Province

High School C ity:

Jeddah

‫ﺍﻟﺩﻭﻟﺔ ﺍﻟﺗﻲ ﺣﺻﻠﺕ ﻋﻠﻳﻬﺎ ﺷﻬﺎﺩﺓ ﺍﻟﺛﺎﻧﻭﻳﺔ‬
‫ﺍﻟﻣﻧﻁﻘﺔ‬
‫ﺍﻟﻣﺩﻳﻧﺔ‬
‫ﺍﻟﺭﻣﺯ ﺍﻟﺑﺭﻳﺩﻱ‬

High School Postal C ode :

‫ ﻣﺛﻝ ﺍﺳﻡ ﺍﻟﺷﺎﺭﻉ‬: ‫ﻋﻧﻭﺍﻥ ﺍﻟﻣﺩﺭﺳﺔ‬

High School Addre ss:

Continue

Reset

© 2000 -2009 Faulk ne r Unive rsity
5345 Atlanta Highway, Montgom e ry, AL 36109 · 334.272.5820 or 800.879.9816 · Privacy / Le gal

https://ww2.faulkner.edu/secure/eli/highschool.cfm

1/1

8/23/12

English Language Institute

Faulkner University

English Language Institute Application for Admission

‫ﺍﺗﺮﻙ ﻫﺬﻩ ﺍﻟﺤﻘﻮﻝ ﻓﺎﺭﻏﺔ ﻭ ﺍﺿﻐﻂ ﻋﻠﻰ ﻛﻠﻤﺔ‬
continue

Transfer Information
School Nam e :
School Addre ss:
School C ity:
School State /Province :
School C ountry:
School Postal C ode :
School Te le phone :
School Fax :
School Em ail:
SEVIS ID:

Would You Like to A dd A nother School?

No

Continue

Reset

© 2000 -2009 Faulk ne r Unive rsity
5345 Atlanta Highway, Montgom e ry, AL 36109 · 334.272.5820 or 800.879.9816 · Privacy / Le gal

https://ww2.faulkner.edu/secure/eli/transfer.cfm

1/1

8/23/12

English Language Institute

Faulkner University

‫ﺿﻊ ﻋﻼﻣﺔ ﺻﺢ ﺑﺠﺎﻧﺐ ﻛﻠﻤﺔ‬
I Agree

English Language Institute Application for Admission
Terms of Enrollment
If acce pte d to Faulk ne r, I agre e to abide by the m oral and e ducational standards of Faulk ne r Unive rsity as de fine d in
the Unive rsity catalog and stude nt handbook . Spe cifically, I ack nowle dge that, if adm itte d as a stude nt at Faulk ne r
Unive rsity, I am e x pe cte d to abide by standards of conduct consiste nt with Biblical principle s. The se standards include ,
but m ay not be lim ite d to, re fraining from inappropriate dre ss, the use of alcohol, drugs, tobacco, and tobacco products,
the use of we apons, vulgar and abusive language , inappropriate inte rpe rsonal re lationships, and the use of any m e dia
that m ay be de trim e ntal to m y spiritual and m oral de ve lopm e nt.

I A gree

I ce rtify that all inform ation provide d by m e re late d to m y adm ission to Faulk ne r Unive rsity is true , com ple te , and
accurate . I give Faulk ne r Unive rsity m y pe rm ission to ve rify any and all inform ation re late d to m y adm ission, including
the inform ation containe d in this application.

I A gree

Summary of Charges
A pplication Fee

$150.00 USD

I20 Processing Fee

$50.00 USD
Total Charges:

‫ ﺩﻭﻻﺭ‬200 ‫ﺭﺳﻮﻡ ﺍﻟﻨﻤﻮﺫﺝ ﻭ ﺍﻷﻱ ﺗﻮﻧﺘﻲ‬

$200.00 USD

Payment

‫ﻗﻢ ﺑﺘﻌﺒﺌﺔ ﺑﻄﺎﻗﺔ ﺍﻹﺗﻤﺎﻥ ﺃﻭ ﺑﻄﺎﻗﺔ ﻣﺴﺒﻘﺔ ﺍﻟﺪﻓﻊ‬

Card Type:
Card Number (No dashes
or space):
Security Code (What's
this?)
Exp Month / Exp Year:
Name (as it appears on
Credit Card):
A ddress:

‫ﻧﻮﻉ ﺍﻟﺒﻄﺎﻗﺔ‬
‫ﺭﻗﻢ ﺍﻟﺒﻄﺎﻗﺔ‬
‫ﺭﻗﻢ ﺍﻟﺒﻄﺎﻗﺔ ﻣﻦ ﺍﻟﺨﻠﻒ‬
/
‫ﺗﺎﺭﻳﺦ ﺇﻧﺘﻬﺎﺀ ﺍﻟﺒﻄﺎﻗﺔ‬
‫ﺍﺳﻤﻚ ﻓﻲ ﺍﻟﺒﻄﺎﻗﺔ‬
‫ﺍﻟﻌﻨﻮﺍﻥ‬
‫ﺍﻟﻤﺪﻳﻨﺔ‬

City:
Country

Afghanistan

State / Province

Badakhshan Province

Zip Code:

‫ﺍﻟﻤﻨﻄﻘﺔ‬
‫ﺍﻟﺮﻣﺰ ﺍﻟﺒﺮﻳﺪﻱ‬
Continue

‫ﺍﻟﺪﻭﻟﺔ‬

Reset

© 2000 -2009 Faulk ne r Unive rsity
5345 Atlanta Highway, Montgom e ry, AL 36109 · 334.272.5820 or 800.879.9816 · Privacy / Le gal

https://ww2.faulkner.edu/secure/eli/payment.cfm

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