Today's Date:
(mm/dd/yyyy, example: 12/05/2005)
Given
Name:
(as shown or will be shown on your passport)
Family Name:
(as shown or
will be shown on your passport)
Gender:
Female Male
Email Address:
Home Telephone:
Work Telephone:
(Optional - not required)
Fax:
(Optional - not required)
Occupation:
(for example: student,
accountant, engineer, etc.)
Nationality: (Country
of your citizenship)
Country of Birth:
City of Birth:
Date of Birth: Year:
(example 1988)
Home Address:
(number and street name)
Address 2:
(Optional)
Apartment Number:
City:
State/Province:
Country:
Postal Code:
How did you learn about Nomen Global?
Name of friend, family member or agent who referred you to Nomen Global:
Why do you want to study English
at Nomen Global?
FAMILY
INFORMATION
Marital Status:
Check here if your spouse will come with you
Check here if your
children will come with you
Number of children who will come
Note:
If your spouse and/or children will accompany you, you must send us
copies of their passports so we can make an I-20 for each of them.
You do not have to pay any additional fees to either Nomen Global or
the U.S. government for you family members.
HEALTH
INFORMATION
Please list any special medical restriction or conditions such as allergies, dietary restrictions, physical handicaps that we should be aware of and
consider in making preparation for your to come to Nomen (if no problem, type "None"):
COURSE INFORMATION
Number of years you have studied English:
Course you plan to attend:
(For Pinnacle Executive or Freedom Youth programs, contact us.)
Date you plan to enter Nomen Global Language Centers:
(mm/dd/yyyy) example: 01/09/2006
How
long do you plan study at Nomen Global: If you plan to study less than one semester,
indicate here the number of weeks you will study:
Campus where
you plan to attend:
Visa type:
*Note: If you plan to come on a J-1
visa, make sure
your J-1 officer indicates in your documentation that you "must study English" as part of your J-1 Program.
If not, we can assist you to request a Change of Status to
F-1 near the end of your J1 program.
Passport Number:
EMERGENCY CONTACT INFORMATION
Please provide information on someone we can contact in
the event you have an emergency and cannot contact someone
yourself. This may be someone in your home country or in the U.S.
Full Name:
Address:
City:
State/Province:
Country:
Postal Code:
Home Telephone:
Work Telephone:
HEALTH INSURANCE INFORMATION
We highly recommend that you have health and accident insurance while you are in the United States.
This is usually less expensive if you purchase this at home, before you
leave your country. However, many of our students purchase insurance
from an American company once they are here. Please indicate your
choice:
I will purchase insurance before I leave my country
I will purchase insurance once I arrive in the U.S.
(this will cost from $60 - $300 per month for one person)
HOUSING
ASSISTANCE FEE
For your living arrangement ,
select one option: (There is a $100 fee if you want us to help you find
your living arrangement.)
AIRPORT
TRANSPORTATION FEE
Do you wish Nomen Global to provide Airport Transfer Service?
No, I will provide my own transportation (no fee)
Yes, I want Nomen to provide my transportation ($50 fee)
EXPRESS
MAIL FEE
Do you want Nomen Global to send
your documents (I-20 and
Letter of Acceptance) by:
Express Mail ($50 fee)
($100 to Mongolia or Russia)
Regular Mail (no fee, but takes longer and may not be as reliable as
Express Mail)
PAYMENT
METHOD
Select a payment method for the application fee
($100) and
other selected fee(s) (housing, airport, express mail)
PARENTAL
CONSENT
Parental consent:
If the student is under 18 years of age, download an
application form and fill in the student's personal information. The parent
must sign and mail or fax the application
form to us.
PAYMENT OPTIONS
After you press the SUBMIT
button below,
print a copy of the displayed page for your records.
Next, go to the payment page to
pay the application fee and any other fee applicable to you.
Unless
required by the embassy or consulate, we recommend that you pay your tuition and homestay
through your agent or that you wait until you arrive at Nomen.
The
Nomen Global privacy policy:
We will never give, sell or trade your information to any other
person or organization.
We will only use the data you provide to enroll you in the program(s)
you have selected.
Please click on
the submit button once to send your application to us.