For office use only App.

# Date Received:

FLS International
Specialty Tour Application 2023
STUDENT INFORMATION

1. 5.
Family Name(s) First Name Middle Name Country of Citizenship

2. 6.
Street Address Country of Birth

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

Country Telephone Fax

8. Do you require an I-20 form? Yes No

Email Instagram Username

3. Gender Female Male Other 4. Date of Birth (MM/DD/YY) FLS Specialty Tours are cultural and part-time in nature.
In most cases, we recommend participants use a visa
waiver or tourist visa.
PROGRAM SELECTION
9. Please check the start date of the program you wish to attend:

Discover California (age 15+)

+
at Citrus College* Cinema Camp (age 15+) Boston Summer (age 15+) at The Discover Boston
Winter: at Citrus College Newman School* + (age 15+) at Boston Commons* +
Jan 8, 2023 Jun 25, 2023 Jun 25, 2023 Jul 16, 2023

Jan 15, 2023 Jul 16, 2023 Jul 2, 2023 Jul 23, 2023

Jan 22, 2023 Jul 9, 2023

Acting Camp (age 15+)
Jan 29, 2023 at Citrus College Jul 16, 2023

Feb 5, 2023 Jun 25, 2023

University Tour (age 15+) TOEFL or SAT Prep Camp (age 15+)
Feb 12, 2023 Jul 16, 2023 +
at The Newman School*
at The Newman School* +
Feb 19, 2023
Jun 25, 2023 Jun 25, 2023
Feb 26, 2023 Surf Camp (age 15+) at
Jul 16, 2023 Jul 16, 2023
Mar 5, 2023 Citrus College+

Choose One: SAT or TOEFL

Mar 12, 2023 Jun 25 2023

Summer: Jul 2, 2023

Jul 9, 2023 Harvard STEM Camp (age 12+) at

Jun 18, 2023
Boston*
Jun 25, 2023 Jul 16, 2023

Jul 9, 2023
Jul 2, 2023

Jul 9, 2023 Family Program (age 6+) Jul 23, 2023

in Los Angeles
Jul 16, 2022
Dates:
Jul 23, 2023

Jul 30, 2023 Programs last from 1 to 4

weeks. Please contact FLS
Aug 6, 2023 for a quote.

Aug 13, 2023

Winter:

Dec 10, 2023

Dec 24, 2023

9. a + Customizable Program

Program name Start Date Program Length 1 wk 2 wk 3 wk Other

(MM/DD/YY)

EXTRA WEEKS OF STUDY

10. *Extra Weeks: Students may add extra weeks English class for an additional fee

I would like weeks of: (Please choose one)

General English (15hrs/wk) Intensive English (20hrs/ Academic English (25 hrs/wk)
wk)
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.

10. a Program start date (MM/DD/YY) Program end date (MM/DD/YY)

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11.
Family Name(s) First Name Middle Name FLS Center

12. Extra Nights: $65 per night (homestay), $95 per night (dormitory)

Anticipated arrival date (MM/DD/YY) Anticipated departure date (MM/DD/YY)

Students are expected to leave their housing by 12:00 PM on the day after their program ends. Students who request to leave housing after 12:00 PM on Saturday should
note that such requests are not guaranteed. And, if granted, wi ll incur an additional housing change.

13. Health Insurance: mandatory for all students; you may purchase it in your home country. Health insurance is also available from
FLS at $40 per week. Would you like to purchase health insurance through FLS? Yes No

14. If requesting an I-20 (not generally necessary for these programs), would you like your I-20 Form documents to be sent by Express
Mail? Express mail delivery is available for an additional $65 fee. Yes No
Note: for applications received less than three weeks prior to the starting date, the documents must be sent by Express Mail.

15. If requesting an I-20 (not generally necessary for these programs), would you like FLS to process the $350 SEVIS Application Fee for
you? Note: This is only for students who need an 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. Govern-ment, Yes No
not by FLS International.

16. Unaccompanied Minor (additional $100 each way): 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. Yes No
Would you like FLS to provide Unaccompanied Minor Service?

17. Airport transfers are optional and not included in package rate. Will student need airport transfers? Arrival Departure

PAYMENT INFORMATION

21. Please send the following fees with your application:

a. Application Fee - required for all applications (non-refundable) US $
b. If SEVIS processing is requested, payment must be included with application: US $350 (non-refundable) US $
c. If Express delivery is requested, payment must be included with application: US $85 (non-refundable) US $

Please indicate Total Enclosed US $

The charges listed above may be paid by traveler’s 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.
Promotion Code (if applicable)

Please send application and fees to:

21f. American Express MasterCard Visa
FLS International—Administrative Offices
680 E. Colorado Blvd.
Credit Card Number Security Code Ste. 180, Second Floor
Pasadena, CA 91101

Expiration Date Signature Tel: 626-795-2912 | Email: fls@fls.net

22. In case of emergency please contact: (applicable to in-person students only)

Name Telephone

E-mail Address Fax

23. Parental authorization for minors:

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.)

24. Family Visitation:

For minor students (under the age of 18) who intend to arrange a visit with relatives during their FLS program, the student’s 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.

Signature Date (MM/DD/YY)

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