golden gate english language school

VACATION STUDY PROGRAM
Application Instructions | Registration Checklist | Application Form

VACATION STUDY APPLICATION FORM

Applicants for the Vacation Study Program must be 16 years or older.

Please print out and complete this form
1. Applicant's Name:
Family Name 

First Name                          Middle Name
2. Gender: Male  Female 
Date of Birth
month/day/year		 /  / 
3.  Birthplace: 
City / (Province) / Country
  Country of Citizenship:
Country
4. Applicant's Home Country
Address:
Street Address 


City                  Country            Postal Code
  Telephone:
Country Code         Area Code         Number
  Fax:
Country Code         Area Code         Number
  E-mail:
5. Emergency Contact Person in US or Home Country:
Family Name                       First Name

Relationship
  Home Telephone:
Area Code         Number
  Work Telephone:
Area Code         Number
6. When do you want to study at GGLS? From:  To: 
Month/Day/Year  Month/Day/Year
7.

I want to add the Super Intensive English Option to my program for an additional fee. (See Vacation Study Programs information.)

 Yes No

If yes, check one:
 5 Hours per Week Private Instruction
 10 Hours per Week Private Instruction

8.

How many weeks do you plan to study at GGLS? _______ # of weeks

The US Immigration Service requires that you have enough money to cover school and living expenses for the total time you plan to stay at the school. Use the Estimated Expense chart below for the dollar amount needed.

  # of weeks Total for Bank
    2   $1165
    3   $1640
 

 

 4

 

 $2115
    5   $2540
    6*   $2845

*Programs longer than six weeks, use the Estimated Expenses, International Student chart. Special tuition savings begin with 6-week programs.

9. The funds needed for school and living expenses will come from the following sources (check all that apply): 
    Personal Savings (Applicant can sponsor himself/herself.)  
    Family Funds from abroad or in the US
    Sponsor abroad or in the US
10. To verify each item checked in #8, please attach a certified bank letter in English, showing account balance in US Dollars. This letter must be on original bank letterhead and signed by a bank official.
11. Name of Sponsor:
Family Name                       First Name

Relationship
  Address:

City              State/Country         Postal/Zip Code
  Home Telephone:
Area Code     Number
  Work Telephone:
Area Code     Number
  Fax:
Area Code     Number
  E-mail:
  Signature: _____________________________________________________________________
      Sponsor                                        Name Printed                                      Date
12.
Do you have a current SEVIS I-797 payment receipt? (Check one)
 
Yes. Enclose a copy of the I-797. (The date on the receipt must be within 12 months from the date of your visa interview for this application.)
No. GGLS will obtain the form I-797 for you.
13.
Medical Insurance is required for international students*.
 

    You will need to provide proof of medical insurance coverage. Medical insurance can be temporary medical insurance for a visitor/traveler to the U.S. or for a foreign student enrolled in a U.S. school. Please send proof of medical coverage by fax: 1-408-374-9429 or email: vt@goldengatelanguage.com as soon as possible.

*This school is authorized under Federal law to enroll nonimmigrant alien students.
14. Delivery instructions for enrollment documents: (Check one)
 
    Mail - US Address
    Airmail - Foreign Address
    International Express Mail (additional fee) 
    Pick-up at Golden Gate Language Schools 
 
Homestay Application
Student must be 18 years or older for the homestay program.
15. Date you plan to move-in with host family: 

Month/Day/Year
 
  Date you plan to move out.

Month/Day/Year
  How long have you studied English?
Years 
Do you smoke? I do not smoke and I will not live with a family that smokes.
I only smoke sometimes.
I smoke.
 
Many families in California do not host students who smoke. Those who permit smoking require smoking outdoors.
 
Would you stay at a home that has a small dog?
Would you stay at a home that has a large dog?
Would you stay at a home that has a cat?		 Yes
Yes
Yes 		No
No
No
Do you have any allergies or other health problems? Yes No

If yes, please explain
Are there any foods you cannot eat? Yes No
If yes, please list
 
 
  

Please tell us something about yourself such as your hobbies, interests, etc.
Airport Pickup Application
16.
Golden Gate Language Schools can provide pickup and return service for either San Francisco Airport or San Jose Airport. If you need to be picked up at the airport, please give the school at least two weeks advance notice and fill out the form below. Airport return can be arranged with the Host Family Coordinator two weeks before leaving the school.
 

Applicant's Name:

Do you need to be picked up at the airport? 

No, I do not need to be picked up.
Yes, I will send the flight information at a later date (at least 2 weeks before I arrive).
 
Yes, here is the flight information:

Flight Information

Airline and flight number:
Arrival date and time:

Airport Information

San Francisco 
San Jose 


I certify that the information above is complete and correct and that I understand the Terms and Conditions.

Signature

________________________________________________________________________
Applicant or Parent if student is under 18                           Name Printed                        Date
If student is 16 or 17 years old, a Declaration of Guardianship form needs to be signed.

Golden Gate Language Schools
591 W. Hamilton Avenue, Suite 101
Campbell, California, 95008-0521, USA
Phone: 1 (408) 374-9954
Fax: 1 (408) 374-9429
info@goldengatelanguage.com

Copyright © 1998 - 2008 Golden Gate Language Schools, Inc.