Study English in USA, Boston School of Modern Languages, ESL Courses in the United States of America

814 South Street
Boston, MA 02131
Tel: (617) 325-2760
Fax: (617) 325-2763
info@studyenglish.com


**Fields marked with an asterisk are required***
First Name*
Family Name*
Date of Birth*	Age: (mm / dd / yy)
Country of Birth*
Country of Nationality*
Sex*
Profession
Company
Years of English instruction?

Address *Please enter your home address*
Address

City *
State	Postal Code
Country
Telephone*
Cellular Phone
Fax
E-mail*


*Select the course you would like to register for*

Group Instruction (ESL/200)
Number of Weeks
Lessons per Day	(Lessons are 50 minutes)
Part Time: 1 to 5 Lessons per day Full Time: 6 Lessons per day * I-20 given to Full Time students only

Combination Course (ESL/250)
Number of Weeks
Group Lessons (per day)	(Lessons are 50 minutes)
Private Lessons (per day)	(Lessons are 50 minutes)
Group and Private lessons per day should add up to no more than 8

Private Instruction
Number of Weeks
Private Lessons (per day)	(Lessons are 50 minutes)

English + Golf
Number of Weeks
Private Lessons (per day)	(Lessons are 50 minutes)
Golf Lessons (per day)	(Lessons are 1 hour)
Private and Golf lessons per day should add up to no more than 8

Select your Starting Date
Note: If you are at an intermediate level or higher, you may start on any Monday.

I need I-20 Form for a Student Visa* Yes No I will be transfering from another school in the U.S.

After you complete your English course, are you planning to study in an American university?* Yes No


Airport Pick-up
Airport Drop-off
Tours & Trips


Housing Options
Do you require housing?*	Yes No

Apartment
Shared Student Apartment (21 years old and over)
Shared Room
Private Room
Private Student Apartment (21 years old and over)
Number of People
Number of Beds
Executive Apartment
Number of People
Number of Beds
Host Family
Host Family
Shared Room
Private Room

Additional comments or questions


Person or Company responsible for tuition
Name
Title
Company Name
Address

City
State	Postal Code
Country
Telephone
Fax
E-mail
Relationship

Local Contact Person (If applicable)
Name
Address

City
State
Telephone

US $125.00 Application Fee (non-refundable)
US $100 Tuition Deposit (non-refundable)
US $150 Housing Placement Fee if you have requested Homestay or Apartment (non-refundable)
Total US $375.00 Deposit


Payment must be made by either Bank Check US$ (written in English), Bank Transfer or Credit Card:
Check
Bank Transfer
Credit Card