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Application

Apply for the 4-week Intensive English Language Program

Use this form to apply for the program. After filling out this form you will receive a link to the form for paying the $500 deposit by credit card.

If you are paying the $500 deposit by wire transfer, please contact Lupita Garza by email at mgarza@smumn.edu.


Student Information
 
* Family Name
 
* First Name
 
* Middle Name
 
* Gender
  Male     Female    
* Street/Mailing Address
 
* City
 
State
 
* Country
 
* Home Phone
 
* Email Address
 
* Date of Birth (month-day-year)
 
* Citizenship
 
* Country of Birth
 
* Native Language
 

Parent/Guardian Information
 
* Parent/Guardian Name
 
* Occupation
 
* Work Phone
 
Fax Number
 

Emergency Contact Information
 
* Name
 
* Phone Number
 
* Relationship to Student
 

Program Choices
 
* Please select all that you intend to participate in:
  4 Weeks: June 15 – July 12 -- $6000 USD per student
Optional Chicago Trip -- $300 USD per student
Optional TOEFL iBT exam -- $200 USD per student
* Please indicate your level of English Proficiency
  Beginner
Intermediate
Advanced
* TOEFL iBT Score (if applicable)
 
* How did you become interested in De La Salle Institute of Saint Mary's University?
  Academic Reputation
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Alumnus
Christian Brothers (De La Salle)
Brochure
Other
* If other, please explain
 
* Required Fields