IEP Application F1 with Agent

1. About You

Family Name (Surname) *

Please enter the name exactly as shown on passport.

Given Name *

Middle Name

Country of birth *

City of birth *

VERY IMPORTANT: please type the city where you were born.

Country of citizenship *

Birthday *

Format: Month/Day/Year

Sex *

Male
Female

2. Student's Contact Information

It is VERY important that we have a correct address for your HOME and for MAIL. Please include a complete home address. If you receive mail at a different address, include that address below.

Student's home country address (must be student's residence) *

City *

Postal or ZIP Code *

Country *

State *

Email (must be student's email) *

STOP: it is very important that we have an email address for the student. Using the email address of another person will cause problems later. Include an email address ONLY if it belongs to the applicant.

Enter Email Confirm Email

Telephone (must be student's telephone number) *

Mailing address (if different than residence address)

If you receive mail at a different address than your home, you can type it here.

Mailing address phone number (if different than residence phone number)

3. In case of emergency, the person we should contact:

Name *

Relationship to you *

Country *

Emergency contact telephone number *

Emergency contact email address *

4. Program Information

How long do you plan to study at the IEP? *

4 weeks
One session (8 weeks)
Two sessions (16 weeks)
Three sessions (24 weeks)
Four sessions (32 weeks)
Five sessions (40 weeks)

Which session do you plan to attend? Select year: *

Choose an 8-week session: *

Select an eight-week session starting with:

Summer Session
Fall Session A
Fall Session B
Spring Session A
Spring Session B
No, I prefer a 4-week session

Or: choose a 4-week session:

Select a 4-week session if you need a shorter session or an atypical start date. Only choose a 4-week session if you are NOT beginning with an 8-week session.

Campus housing *

Are you interested in living on campus? Campus housing is extremely limited, but we can often arrange housing when we have early notice.

I want to live on campus
I do not want campus housing

How did you learn about Boise State University’s Intensive English Program? *

Your university
Friend or family member
Agent
Internet
Company or business
Student fair
US embassy, consulate, or other government office

Level of education completed *

High school
Some college or trade school
Bachelor's degree
Master's degree
Doctoral degree

English test score

Do you have a score from the TOEFL, IELTS, TOEIC, or other test? Write the test name and score below.

University

Do you attend university? What is the name of your university?

5. Transfer Information

Are you are transferring from another school or program in the U.S.? *

Yes
No

School name *

School address *

6. Financial Support

Please indicate who is responsible for your tuition and living expenses during your study in the U.S.: *

Personal, family or other individual funds
Sponsor (government, agency, company, other)

Name of account holder *

Relationship to You *

Bank name *

Phone *

Address *

Name of sponsor *

Organization *

Address *

Phone *

7. Dependent information

Do you have dependents? *

Yes
No

Name of dependent(s) *

You must list first name, last name, and relationship to applicant. A copy of each dependent's passport will be required.

8. Agent or partner information

If you are working with an agent or partner university, the information below is required.

Name of agent or university coordinator: *

Agent's company or university name: *

Agent's or partner's email address *

Permission to share information with an agent or partner university *

If the student would like the Intensive English Program at Boise State University to be able to share information with an agent or partner university, please read the following statement. By adding your signature and date, you are digitally signing your agreement to the statement of permission: "I, the person applying to the IEP, give my permission for the Intensive English Program at Boise State University to share information with employees of the above-listed agency or partner university, including admissions information, acceptance information, shipping information, student ID number, student email address, information on creating a password for BSU, SEVIS ID number, grades, and other relevant information. I give permission to Boise State University to release the specified information to the recipient listed above. I understand that by signing this release I am waiving my right to keep this information confidential under the Family Education Rights and Privacy Act (FERPA). I certify that my consent for disclosure of this information is entirely voluntary." Type your name and date in the box to digitally sign this agreement of permission.

Passport and Financial Documents

Please upload a copy of your (1) passport, (2) financial document, and (3) written task. Also upload passport copies for any dependents. PDFs are preferred. *

Drop files here or

Max. file size: 10 MB.