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2010 APPLICATION AND I-20 REQUEST FORM
FOR THE SIX-WEEK INTENSIVE PROGRAM
Term name:_____________________________
Month term begins:_______________________ Year of term:_____________
Student Name (as it appears on the student's passport):
Last Name: ______________________________
First Name: __________________________ Middle Name: _____________________
Birthday: Month: ______________ Day: ____________ Year: _____________
Male or Female
Country of Birth: _________________ Country of Citizenship: _______________
Mailing Address for I-20:________________________________________________
______________________________________________________________________
Postal Code:_____________________ Country: ______________________________
Student's Home Address (if different): ____________________________________
______________________________________________________________________
Postal Code:_____________________ Country: ______________________________
Telephone Number: ______________________ Fax Number: ____________________
E-Mail Address: ________________________________
I would like to attend the MLC intensive English program beginning
month__________, year______. I am enclosing the $100.00 non-refundable
advanced tuition deposit or the MasterCard/Visa Authorization Form. The
$100.00 non-refundable deposit will be applied to my first term's
tuiton. Please send me the Form I-20.
STUDENT SIGNATURE__________________________ Date:_________________
(If you plan to come to the United States with dependents, please notify the MLC.)
UNIVERSITY TOWERS HOUSING REQUEST FORM AND CONTRACT
__ Do not reserve housing for me.
__ 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 $825.00 per 6-week
term* and $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 $1325.00 per 6-week
term* and $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.
(There are a limited number of single rooms available.)
*Housing costs are subject to change
__ OPTIONAL BED & BATH PACKAGE: Please reserve an optional Bed and
Bath Package for me. The cost of a Bed & Bath Package is $65.00. I
understand that I must reserve a Bed & Bath Package in advance and
that the Bed & Bath Package contains the following: Blanket;
Pillow; Pillowcase; Bath towel; and Hand towel. These items are sold as
a package, If a student does not reserve a Bed & Bath Package in
advance, the student should bring these items from his/her own country.
ADDITIONAL HOUSING RELATED CHARGES PER PERSON
Utility Charge: 6-week term=$60.00/person
3-week term=$40.00/person
Cleaning Fee: $30.00/person for each 3-week or 6-week term
Refundable Key and Damage Deposit: When a student first moves into
University Towers, a $150.00 refundable damage deposit is collected
from each student to cover the cost of the keys and damage to the
apartment. The deposit is returned to the students within 30 days after
the student leaves the apartment if the keys are returned and there is
no damage to the apartment.
I have agreed to rent either a shared or a single bedroom for the term
stated on the application on the other side of this page. I understand
that if I have reserved a shared or a single bedroom at University
Towers and I have entered the United States, I am responsible for
paying the total housing fee for the term unless I cancel my
reservation in writing 14 days prior to the published University Towers
move-in date. If I continue to study at the MLC for additional terms, I
will have the option to continue to rent at University Towers or to
arrange my own housing.
STUDENT SIGNATURE__________________________ DATE_________________
STATEMENT OF FINANCIAL RESPONSIBILITY
Applicant's Name (Typed or Printed)_____________________________________________________
I understand that the tuition at the Michigan Language Center is
$1250.00* for each six-week term, and books cost approximately $125.00
per six-week term. Living expenses are estimated to be between $1465.00
and $2000.00 for each six-week term. Therefore, an intensive student at
the MLC should have at least $2840.00 available to him or her for each
six-week term of study to pay for tuition, books and living expenses. I
agree to be responsible for these expenses.
Signed___________________________________________________Date_______________________
* Tuition is subject to change.
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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
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