ELC Home   RIT Home   A-Z Index   myRIT   Search   Email Us

Application Form

Rochester Institute of Technology
English Language Center Application

Please print this form, sign, and send it to:
Rochester Institute of Technology
English Language Center
28 Lomb Memorial Drive
Rochester, NY 14623, U.S.A.

Date:

Month

Day

Year

Family Name:
Given Name:
 
Home Address:

       
Are you currently in the U.S?  
If yes, what kind of visa do you have?
       
Birthdate: Month Day Year
Gender: Male Female
Country of Birth:
City of Birth:
Country of Citizenship:
TOEFL (optional) Score:
Date Taken: Month Day Year
Home Phone Number:
Cell Phone Number:
E-mail address:
Student's signature:

Please indicate your present knowledge of English.
Speaking Good Fair Poor
Reading Good Fair Poor
Writing Good Fair Poor

I am interested in applying for:
Fall
Winter (11 weeks)
Winter (8 weeks)		 Spring
Summer (11 weeks)
Summer (7 weeks)		    

I will need a dormitory room. Yes
No
If yes: I smoke. I do not smoke.
I do not need a dormitory room. I will be living with a friend or relative in Rochester.

Name of a friend or relative in the U.S. whom we can contact:
Name:
Address:
Address:
Telephone:
My family is coming with me; I would like an RIT apartment.

FEES:
$100 non-refundable application fee by check or money order in U.S. funds (required)
$0 for express mail (optional)
$0 if you want airport pickup (optional). Please pick me up at the airport. I have enclosed $0 for this service. I will tell you when my flight will arrive in Rochester.
$200 if you want us to pre-pay the U.S. government-required SEVIS fee and send the receipt to you.

You may send one check for all expenses.

We cannot process your application for the I-20 form until we receive the original signed application and sponsor forms, all supporting documents and a check for the required fees.

Send originals, supporting documents and required fees by mail to the English Language Center.

Thank you.

RIT will admit and hire men and women; veterans; persons with disabilities; and individuals of any race, creed, religion, color, national or ethnic origin, sexual orientation, age, or marital status in compliance with all appropriate legislation.