English School in New York City | PALS NYC | Professional ESL Classes in Accent Reduction, Speaking, and Writing

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Course Information

Check the term's you plan to attend
(if for next year's term please select that year from the box to right of your term)

Spring Term	Summer	Fall
Full term (14 weeks)	Term A (6 weeks)	Full term (14 weeks)
Term A (7 weeks)	Term B (6 Weeks)	Term A (7 weeks)
Term B 7 (weeks)		Term B 7 (weeks)

Please check the courses you plan to choose:

Core Curriculum (F-1 and all full-time students check all courses)
	Accent Reduction
	Listening & Speaking
	Composition & Grammar
	Reading & Vocabulary
	Culture & Worldview
	English Conversation Groups (given to all students)
Elective Courses (subject to availability):

	Business Marketing Internship

Personal Information

Full Legal Name:
	Family Name / Last Name	Given / First Name	Middle Name (if applicable)

Date of Birth:	(month/day/year)	Gender:
Marital status:		Country:
Country of Citizenship:		Native Language:

Who is responsible for tuition?
Are you currently Employed?:		If so where?:

Contact Information

Mailing Address (Where official documents will be sent by school)

Street address

PO BOX / Apartment / Suite

City

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Home Phone

Work Phone

Fax

Primary E-Mail address

Permanent Home Address (Check here if same as Above)

Street address

PO BOX / Apartment / Suite

City

Prefecture/State/Province

Country Postal Code

Home Phone

Fax

Emergency Contact Information

Contact Person's Name:	Family Name / Last Name	Given / First Name
Telephone Number:

Educational Information

Have you graduated from high school?
Graduation year or Expected Graduation Year:		Month/Day/ Year
Have you graduated from college or university?
Graduation year or Expected Graduation Year:		Month/Day/ Year
English Proficiency:
Have you taken the TOEFL within the past 2 years?
Which type of TOEFL?		TOEFL score:
Date of TOEFL

Plans after studying English

What are your plans after completing English language study?

If you plan to go to work what industry or company do you plan to apply for:
Other plans please explain:

Initial Interest

How did you learn about Program for American Language Studies ?

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Health Insurance

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If you answered YES please be prepared to submit proof of health insurance coverage.

I certify that the information included in this document is true, correct, and complete to the best of my knowledge, and I understand that deliberately providing false information is grounds for denial or withdrawal of an acceptance. Furthermore, I shall promptly inform Program for American Language Studies if there is a change in the facts indicated.

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