NEW YORK UNIVERSITY

New York University
A private university in the public service
School of Continuing and Professional Studies
The American Language Institute
I-20 APPLICATION
15 Barclay Street, Room 228
New York, NY 10007
Telephone: (212) 992-8331
Dear Waseda International Applicant:
Thank you for your interest in New York University’s American Language Institute and the special threeweek program we are offering for Waseda students in February 2015. All international students who plan
to enroll in this full-time English as a Second Language program must obtain a student (F-1) visa. In order
to receive a student (F-1) visa, you must begin by applying for a Certificate of Eligibility (I-20 Form).
Please read the enclosed information before completing the application.
To receive a Certificate of Eligibility (I-20 Form), you must submit the following:
1) Completed application for Certificate of Eligibility (I-20 Form).
2) Copy of passport bio page.
3) Financial Guarantee Letter indicating English as a Second Language as program of study, fees which
will be provided by the sponsor and length of sponsorship period on organization/agency letterhead.
Upon receiving your application and supporting documents, an acceptance letter and I-20 form will be
mailed to Waseda University so that you can apply for a student (F-1) visa at your nearest U.S. Embassy or
Consulate.
We look forward to receiving your completed application.
Sincerely,
Ms. Mary Chung
International Student Advisor
Application Fee $150 (To be submitted with school fees)
NEW YORK UNIVERSITY
A private university in the public service
RCD: ______________________
School of Continuing and Professional Studies
THE AMERICAN LANGUAGE INSTITUTE
15 Barclay Street, Room 228
New York, NY 10007
Tel: (212) 992-8331
APPLICATION FOR CERTIFICATE OF ELIGIBILITY (I-20 FORM) FOR FULL-TIME WASEDA/ALI PROGRAM
(February 9, 2015 to February 27, 2015)
You must enroll in a full-time English as Second Language program in order to
maintain F-1 student status in the United States.
1.
Name of Applicant
(According to your Passport)
2.
Sex:
4.
Country of Birth:
Female
Family Name
Given Name
Middle Name
3. Date of Birth: Month
Male
Day
Year
5. Country of Citizenship:
6. Permanent Home Address outside of the U.S.(No business or PO Box addresses. No Express Mail service to PO Box addresses.)
_______________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
City
State/Province
Country
Postal Code
________________________________________________________________________________________________________________________
Telephone:
7.
Student’s E-mail Address:
Student’s Local Home Address in U.S., if available at this time:
_____________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
City
State
Postal Code
Telephone:
8. Family member or friend to be notified in case of emergency. ____________________________________________________________
Name
•
•
•
•
Relation to You
Telephone/Email
PLEASE READ THE FOLLOWING STATEMENTS AND SIGN WHERE INDICATED
I understand that New York University reserves the right to refuse admission to any applicant who, in the University’s judgement, is not
qualified. Similarly, in order to safeguard its ideals of scholarship, character and personal behavior, the University reserves the right to require
the withdrawal of any student at any time for any reason deemed sufficient under the rules and practices of the University.
I further understand that admission to New York University’s American Language Institute in no way implies admission for academic study for
a degree or as a special student to any academic division of NYU. Applicant must be at least 18 years old to be considered for admission.
I understand that the I-20 form is to be used only if I intend to enroll in the ALI at NYU.
I certify that the information given in this application is complete and accurate.
Date
Signature of applicant
PROGRAM EXPENSES AND REQUIREMENTS FOR F-1 STUDENTS
YOU ARE REQUIRED TO CERTIFY THAT FUNDS ARE AVAILABLE FOR THE LENGTH OF YOUR
PROGRAM AT NEW YORK UNIVERSITY’S AMERICAN LANGUAGE INSTITUTE, EXCLUSIVE OF
TRAVEL EXPENSES. IN COMPUTING YOUR FINANCIAL RESOURCES, YOU SHOULD BEAR IN
MIND THAT YOU WILL NOT BE PERMITTED TO WORK. TUITION AND ESTIMATED LIVING
EXPENSES ARE LISTED BELOW.
Course and Participation Expenses
Tuition and Fees:
$3,600
(Inclusive of application, registration, insurance, mandatory university fees, and class materials/textbooks)†
‡Living expenses
Estimated Total Expense:
$1,700
$5,300
†The NYU Student Health Insurance Plan is required of all full-time students who are not covered by
personal/family insurance while in the U.S. Students must provide proof of comparable personal/family health
insurance to be waived from participation in this University Insurance Plan. These fees are estimated and are
subject to change. For more information on the NYU Student Health Insurance Plan benefits, students should refer to
the most recent Guide to Student Health Insurance at the following website:
https://nyu.consolidatedhealthplan.com/student_health/new_york_university.html
‡
Living expenses are estimated at $1700.00 per month to cover rent, food and transportation – exclusive of travel
to/from the U.S. and clothing.
______________________________________________________________________________________
Cancellation Policy:
More than 30 days before the first day of the Program there is no cancellation fee, but the student is required to cover
any expenses incurred by NYU School of Professional Studies;
Fewer than 30 days but more than 15 days before the first day of the Program, the program cancellation fee is 25% of
the total Program Fee plus any costs incurred by NYU School of Professional Studies;
Fewer than 15 days before the first day of the Program the program cancellation fee is 50% of the total Program Fee
plus any costs incurred by NYU School of Professional Studies.

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