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FLS International

English Language Programs


Student Information
1 Name
Family Name(s) First Name

2014

Specialty Tour Application


For office use only App. #: Date Received: / / 5 Country of Citizenship
Middle Name

2 Student Permanent Home Address

6 Country of Birth
Street Address

7 Where did you obtain this application?


City State/Department/Province Postal Code

Country

Telephone

Fax

8 Do you require an I-20 form?


E-mail

Yes

No

3 Gender

Male

Female

4 Date of Birth
Month Day Year

Program Selection
9 Please check the start date of the program you wish to attend

Discover California
at Citrus College

Discover California Junior


June 22, 2014 June 29, 2014 July 6, 2014 July 13, 2014 July 20, 2014 July 27, 2014 August 3, 2014

California Summer
at Cal State, Northridge

Basketball Camp
at Fisher College

Discover Boston
at Boston Commons

January 5, 2014 January 26, 2014 March 9, 2014 March 23, 2014 June 22, 2014 June 29, 2014 July 6, 2014 July 13, 2014 July 20, 2014 August 10, 2014 December 14, 2014 December 21, 2014 December 28, 2014

at Sonrise Christian School

June 29, 2014 July 6, 2014 July 13, 2014 July 20, 2014

June 29, 2014 July 13, 2014

Outdoor Adventure Camp


at Tennessee Tech

August 3, 2014 December 14, 2014 December 21, 2014

University Tour East


at Boston Commons

Junior Camp
June 29, 2014 July 6, 2014 July 13, 2014 July 20, 2014

at Cal State, Northridge

June 29, 2014 July 13, 2014

July 13, 2014

Boston Summer
at Fisher College

Surf Camp

Tennis Camp
at Tennessee Tech

at Saddleback College

Cinema Camp
June 22, 2014 July 6, 2014 July 13, 2014

June 29, 2014 July 6, 2014 July 13, 2014 July 20, 2014 (2-week)

Photography Camp
at Las Vegas Institute

June 29, 2014 July 13, 2014

at Saddleback College

June 29, 2014 July 13, 2014

Hip-Hop Dance Camp


at Fisher College

June 29, 2014 July 6, 2014 July 13, 2014 July 20, 2014

TOEFL/SAT Prep
at Fisher College

Acting Camp
June 22, 2014 July 13, 2014

at Saddleback College

Culinary Camp
July 13, 2014

June 29, 2014 July 13, 2014

at Las Vegas Institute

June 29, 2014 July 13, 2014

Extra Weeks of Study


10 Extra Weeks: students may add extra weeks of General English study for an additional $700 per week. I would like
Weeks

weeks of General English.

Please indicate the revised start and end date of your program including your additional weeks of study. Students may start their program on any Monday and end on any Friday.

Program start date

Month

Day

Year

Program end date

Month

Day

Year

11 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

Continued on Reverse Side

FLS International
English Language Programs
Student Information
12 Name
Family Name(s) First Name

2014

Specialty Tour Application


FLS Center
Middle Name

13 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 14 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

15 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 entered below. This fee will be charged by the U.S. Government not by FLS Interna-

No

16 Unaccompanied Minor: Upon request, 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. Cost is $100 round-trip. Would you like FLS to provide Unaccompanied Minor Service? Yes No Note: if you request the Unaccompanied Minor Service from your airline, you must also select this fee for FLS service.

Payment Information
17 Please send the following fees with your application: A. Application processing feerequired for all applications (non-refundable) B. If SEVIS processing is requested, payment must be included with application: US $200 (non-refundable) C. If express delivery is requested, payment must be included with application: US $55 (non-refundable) D. If unaccompanied minor service is requested, payment must be included with application: US $100
The charges listed above may be paid by travelers check, personal check, international money order, bank draft, or transfer on a USA bank. Please note that all charges must be paid in US dollars. These charges may also be paid by credit card. Only Visa, MasterCard, or American Express cards are accepted. Please do not send cash through the mail.

US $ 150 US $ US $ US $ Please Indicate Total Enclosed US $

18 Promotion Code Please mail application, fees, and a financial statement to: FLS InternationalAdministrative Offices 301 N. Lake Ave., Suite 310 Pasadena, CA 91101, U.S.A. Tel: (626) 795-2912 | Fax: (626) 795-5564 | E-Mail: fls@fls.net

American Express
Credit Card Number

MasterCard

Visa
Security Code

Expiration Date

Signature

19 In case of emergency please contact:


Name Telephone

E-mail Address

Fax

20 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, guardian, etc.)

21 Family Visitation: For minor students (under the age of 18) who intend to arrange a visit with relatives during their FLS program, the students parent or guardian must complete and sign a Family Visit Authorization Form. This form may be obtained upon request from any FLS staff member or agent.