APPLICATION PROCESS FOR APPLYING TO ATTEND THE SPECIAL 3-WEEK INTENSIVE PROGRAMS

To register for the Term 5A, 5B, 6A, 6B, or Holiday 3-Week programs, please print the following application form, complete it and sign it in the appropriate places. Mail your application form with a $100.00 non-refundable tuition deposit. The remainder of the tuition, $660.00 will be due on registration day. Students will also be expected to purchase textbooks at a local bookstore. Space is limited and each applicant will be considered on the basis of the arrival date of his/her application and deposit.

PLEASE NOTE: A student who is interested in attending Terms 5A and 5B, or 6A and 6B should consider attending the Term 5 or Term 6 6-week intensive program. The cost of attending the Term 5 or Term 6 6-Week Intensive Program is much less than the combined costs of the 3-Week Intensive Programs.

Family name:_______________________________________________________________________

First name:_________________________________________Middle name:_____________________

Birthday (Month, Day, Year):_________________________     Male / Female (circle one)

Country of Birth: ___________________________Country of Citizenship:_____________________

Complete Address:___________________________________________________________________

__________________________________________________________________________________

Fax#:_________________________________ Telephone#:__________________________________

E-Mail Address:_____________________________________________________________________

Signed ______________________________________________Date __________________________

University Towers Housing Request Form and Contract

Do not reserve housing for me. I will make my own housing arrangements.

 I would like to reserve a shared bedroom at University Towers.  I understand that I will share 1 bedroom in a 2-bedroom apartment, and that the 2nd bedroom will have 1 or 2 other students.  I understand that the cost of a shared bedroom is $550.00 per 3-week term. I am enclosing the total amount of the housing fee by US check or by MasterCard/Visa Authorization Form.

 I would like to reserve a single bedroom at University Towers.  I understand that I will have my own bedroom in a 2-bedroom apartment, and that the 2nd bedroom will have 1 or 2 other students.  I understand that the cost of a single bedroom is $795.00 per 3-week term. I am enclosing the total amount of the housing fee by US check or by MasterCard/Visa Authorization Form.

Refundable Key and Damage Deposit: When a student first moves into University Towers, a $150.00 refundable deposit is collected from each student to cover the cost of the keys and damage to the apartment. This deposit is returned to the student within 30 days after the student leaves the apartment if the keys are returned and if there is no damage to the apartment.

Optional Bed and Bathroom Package: A student may purchase a Bed and Bathroom Package from the MLC for $65.00. The Bed and Bathroom Package includes the following: 1)Fitted bottom sheet; 2)Top sheet; 3)Blanket; 4)Pillow; 5)Pillow case; 6)Bath towel; 7)Hand towel. These items are sold as a package only. It is not possible for the MLC to lend or sell part of a Bed and Bathroom Package. A Bed and Bathroom Package must be reserved in advance. If a student does not purchase a Bed and Bathroom Package, the student should bring these items from his/her country.

I would like to reserve a Bed and Bathroom Package for my apartment at University Towers. I have enclosed $65.00. I understand that the MLC will provide me with the following: 1)Fitted bottom sheet; 2)Top sheet; 3)Blanket; 4)Pillow; 5)Pillow case; 6)Bath towel; and 7)Hand towel.

OR

I do not want to reserve a Bed and Bathroom Package. I understand that I must bring my own sheets, pillow, pillow case and towels and that the MLC will not provide me with these items.

Signed _____________________________________________Date ___________________________

STATEMENT OF FINANCIAL RESPOSIBILITY FOR THREE WEEK INTENSIVE PROGRAM

I understand that the tuition at the Michigan Language Center is $760.00 for the three week term, and the cost of materials will be beween $70.00-$90.00. Living expenses are estimated to be $785.00 for the three week term. Therefore, an intensive student at the MLC should have $1600.00 available to him or her for the three week term of study to pay for tuition, books and living expenses. I agree to be responsible for these expenses.

I also understand that the Michigan Language Center will notify the Immigration and Naturalization Service if a student arrives in the United States without adequate funds or if a student does not maintain his or her student status by studying full time.

Signature of applicant_____________________________Date________________________________

Signature of person who is financially responsible for applicant _______________________________

Date________________________________

MASTERCARD AND VISA CHARGE AUTHORIZATION FORM 

Check One: Mastercard Or Visa 

As the cardholder, I give my permission for the following charges to be made on my credit card: 

DHL Express Mail Courier charge of $_________________________
            *DHL prices change very frequently.  Please contact the MLC for DHL rates.

Other __________________________________________________________________

TOTAL AMOUNT TO BE CHARGED:________________ 

Account Number:#__________________________________ 

PLEASE READ AND SIGN:
I understand that the Application and Advance Tuition Fee and the Housing Deposit and Reservation Fee are Non-Refundable. 

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Michigan Language Center
309 S. State St.
P.O. Box 8231
Ann Arbor, MI 48107, U.S.A.
Tel: (734) 663-9415
Fax: (734) 663-9623
E-Mail: mlc-usa@att.net