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FLS International

English Language Programs
Student Information
1 Name
Family Name(s) First Name Middle Name


Admission Application
For office use only App. #: Date Received: / / 5 Country of Citizenship 6 Country of Birth

2 Student Permanent Home Address

Street Address

7 Where did you obtain this application?
City State/Department/Province Postal Code




8 Are you a transfer student?

Yes Yes

No No

3 Gender



4 Date of Birth
Month Day Year

9 Do you require an I-20 form?

Program Selection
10 Please check program type 11 Please check the program length in weeks 1 week 3 weeks 5 weeks 4 weeks 6 weeks 2 weeks Academic English TOEIC Prep 7 weeks 8 weeks Intensive English IELTS Prep 12 weeks 16 weeks General English GMAT Prep 20 weeks 24 weeks Vacation English GRE Prep 32 weeks 52 weeks Other


12 Please check the center you wish to attend (For a list of program availability by center, review the FLS brochures or visit Saddleback College, California Las Vegas Institute, Nevada Lock Haven University, Pennsylvania Citrus College, California Boston Commons Center, Massachusetts Tennessee Tech University, Tennessee 13 Please check the date when you wish to begin January 13, 2014 April 7, 2014 February 10, 2014 May 5, 2014 March 10, 2014 June 2, 2014 June 30, 2014 July 28, 2014 August 25, 2014 September 22, 2014 October 20, 2014 November 17, 2014 December 15, 2014 Other Date
Month Day Year

Start any Monday

Housing Selection
14 Please indicate housing preference: Would you like FLS International to arrange your housing? Homestay
Please Specify*



Twin Room

Single Room

* Twin Room: Two students per room Single Room: One student per room, with other housemates in the house Twin Room Only (Citrus College, Saddleback College, Tennessee Tech University) Shared Room Only (Lock Haven University, Tennessee Tech University, and Boston Commons) Shared Room Only (Boston Commons)

Students requesting homestays are asked to complete the additional Homestay Application Form

Apartment Dormitory International House

Please note: students should arrive on the Sunday prior to their term’s starting date, and leave on the Saturday after completing their program. Early arrivals and late departures should plan to stay in a hotel or be charged a daily housing rate, unless other arrangements have been made with FLS. Any student requesting housing at the International House is subject to a $385.00 cancellation fee if cancelling less than 30 days prior to the start of their program.

15 Extra Nights: $55 per night (homestay), $75 per night (apartment, dormitory, International House) Anticipated arrival date
Month Day Year

Anticipated departure date
Month Day Year

16 Health Insurance: mandatory for all students; you may purchase it in your home country. Health insurance is also available from FLS at $35 per week. Would you like to purchase health insurance through FLS? Yes 17 Would you like your I-20 Form and acceptance documents to be sent by Express Mail? Express mail delivery is available for an additional $55 fee. Note: for applications received less than three weeks prior to the starting date, the documents must be sent by Express Mail. Yes

No No

18 Would you like FLS to process the $200 SEVIS Application Fee for you? Yes Note: this is only for students who need a student F-1 visa from the US Embassy. If YES then a valid credit card must be submitted. This fee will be charged by the U.S. Government not by FLS International.


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If SEVIS processing is requested. The statement should be a letter from a financial institution. No Airport Pick-Up or Drop-off Needed FLS Saddleback College FLS Citrus College FLS Las Vegas Institute FLS Tennessee Tech University FLS Lock Haven University Los Angeles International Airport (LAX) Los Angeles International Airport (LAX) Las Vegas McCarran Airport (LAS) Nashville International Airport (BNA) University Park Airport (SCE) Harrisburg International Airport (MDT) Philadelphia International Airport (PHL) Boston Logan Airport (BOS) Pick-up (LAX)—$150 Pick-up (LAX)—$150 Pick-up (LAS)—$85 Pick-up (BNA)—$145 Pick-up (SCE)—$85 Pick-up (MDT)—$175 Pick-up (PHL)—$300 Pick-up (BOS)—$110 Drop-off (LAX)—$150 Drop-off (LAX)—$150 Drop-off (LAS)—$85 Drop-off (BNA)—$145 Drop-off (SCE)—$85 Drop-off (MDT)—$175 Drop-off (PHL)—$300 Drop-off (BOS)—$110 FLS Boston Commons 20b Unaccompanied Minor: Upon request. If unaccompanied minor service is requested.FLS International English Language Programs Student Information 19 Name Family Name(s) First Name Middle Name 2014 Admission Application FLS Center 20a Airport Pick-Up and Drop-Off : FLS International can provide Airport Pick-Up on the Sunday before the program starts to ensure a reliable greeting at the airport and door-to-door transportation. Payment Information 21 Please send the following fees with your application: A. or American Express cards are accepted. See schedule for approximate expenses.S. fees. fees. Application processing fee—required for all applications (non-refundable) B. Please note that all charges must be paid in US dollars. I understand that the approximate tuition.) 25 Financial Statement: (For F-1 visa students only) An affidavit or financial guarantee showing sufficient financial resources for the intended term of study is required from the applicant or parent. payment must be included with application: US $200 (non-refundable) C. Only Visa. Tel: (626) 795-2912 | Fax: (626) 795-5564 | E-Mail: fls@fls. I certify that the information shown above is true and correct: Signature Month Day Year . etc.. international money order. and living expenses are US $ 2000 per 4-week term.A. government or sponsor. Lake Ave. Please do not send cash through the mail. you must also select this fee for FLS’ service. CA American Express Credit Card Number MasterCard Visa Security Code Expiration Date Signature 23 In case of emergency please contact: Name Telephone E-mail Address Fax 24 Parental authorization for minors: (Must be completed for all students under 18 years of age) I authorize FLS International and its agents to allow any necessary and appropriate emergency medical services for my child in case of accident or illness and release them from all liability. Signature Relationship to student (parent. Would you like FLS to provide Unaccompanied Minor Service? Yes No Note: if you request the Unaccompanied Minor Service from your airline. If express delivery is requested. and a financial statement to: FLS International—Administrative Offices 301 N. MasterCard. US $ 150 US $ US $ US $ Please Indicate Total Enclosed US $ 22 Promotion Code Please mail application. These charges may also be paid by credit card. bank draft. or transfer on a USA bank. personal check. U. Suite 310 Pasadena. Cost is $100 round-trip. I also realize that the tuition and fees for intended term of study are payable in full upon registration. payment must be included with application: US $100 The charges listed above may be paid by travelers check. FLS will provide the name and contact information of a specific designated driver to the agent and airline for pick-up and provide chaperone service to airport security for airport drop-off. payment must be included with application: US $55 (non-refundable) D. guardian.