Registration

If you would like to register on-line, please complete the form below and click submit. You may also register in person at our office in Gaithersburg.

Please note that your credit card will not be processed on-line. We will only charge your credit card if we have all necessary information to process your application. All tuition charged is refundable if enrollment is cancelled before the scheduled start of classes.

I-20 forms can only be issued if all necessary fees and documents have been received. A financial guarantee in the form of a recent bank statement, and/or a sponsor letter or an affidavit of support is needed before we can issue an I-20 for any prospective student.

Our site is secured with an SSL Certificate. Your entered information will be encrypted and protected when it is transmitted online.

On-line Application Form *required

I. Student Information:

First Name:*
Middle Name:
Last Name:*
Gender:*		Male Female
Date of Birth (mm/dd/yy):*		/ /
City of Birth:*
Country of Birth:*
Native Language:*
Country of Citizenship:*
Profession:
Education Level:
Current US Address (if applicable)
Street:
City:
State:
Zip Code:
Foreign Address
Street:*
City:*
State/Province:*
Postal Code:*
Country:*
Home Phone:*
Cell Phone:
Email:*
Emergency Contact:
Emergency Contact Phone:

II. Program Information:

I would like to register for the following program:*

Expected Start Date:*		(mm/dd/yy)
For how many weeks? *

III. Visa Information (non-F-1 students: please skip to section IV):

Do you currently have an F-1 Visa?	Yes	No
Do you need an I-20 Form to apply for an F-1 Visa?*	Yes	No
If yes, please select one:
Will you bring dependants? If yes, please select	(the number of dependants)
How do you want to receive the I-20 Form?	Pick up at International Language Institute of Maryland
How do you want to receive the I-20 Form?	Express Mail/Courier ($15-$100)

IV. Payment Information:

The registration fee is due at time of enrollment. Tuition is due the first day of class. A late fee of $15.00 per week is automatically added to any payment made more than 3 days late. Payments for the Intensive Program are made in full for 8 weeks unless a student has fewer than 8 weeks to complete their program or has permission from the School Director to enroll for fewer than 8 weeks.

	Registration Fee	$50
	+ Tuition
	+ SEVIS Registration Fee $200	(if applicable)
	+ Express Mail/Courier (for I-20)	(if applicable)
	= Total Initial Payment Due
	*I agree to the International Language Institute's refund policy: The $50 Registration Fee and all processing fees are non-refundable. A full refund will be made for tuition paid made in advance of a class start if a visa or change of status request is denied or if the enrollment is cancelled before the start of class. A full refund will be made for classes cancelled by the International Language Institute, MD. There is no discount or refund for days on which ILI is closed because of holidays, bad weather or other emergencies. A refund for early withdrawal will be made if a student completes a refund request form by the last day of attendance. The weekly tuition rate will be used to calculate the amount of tuition retained for the weeks attended. Any portion of a week attended will count as a week attended for this purpose. Refunds will be issued within 30 days of the date on the refund request form.

Payment by:*	Visa MasterCard American Express Bank Wire Western Union
Credit card number:
Expiration date:	Month Year
Name of Card holder:
Card ID (required)	more info
Street address of card holder's billing address (required):

Postal or zip code of card holder's billing address (required):

The credit card will not be charged unless registration and supporting documents are received. A receipt will be mailed to you and you will be notified by email when charged. If you select bank wire, we will email you our bank wire information after you submit this on-line application. Bank wire fees have to be paid by the sender and the full initial payment due has to be received before we can process your application.

V. Signature:

Internet signature of person responsible for the account:*
	(please enter your name here)