Word-Wide ESL Institute

4843 Voltaire Street, Suite A, San Diego, CA 92107

Tel: (619) 222-6411 Fax: (619) 222-6404

study@wordwide.US

APPLICATION FORM

Family Name: __________________________ First Name: _______________________ M.I./Name________ Sex: □ Male □ Female

Country of Birth: ________________________Country of Citizenship: ______________________ Date of Birth: _________/____/______

Month Day Year

U.S. Address: ____________________________________________________________________________________________

No. Street Apt City State Zip Code

Student Phone: _______________________ Cell Phone: _______________________ E-Mail: _________________________________

Foreign Address: _______________________________________________________________________________________________

Please write your address in the order it is usually written in your country, including number, floor, street, etc.

_____________________________________________________________________________________________________________

City State/Province Postal Code Country

Desired Start Date: _______ /_____ /______ (You may start any Monday. For one 10-week Level, please use Academic Start Dates)

Month Day Year

Desired End Date: _______ /_____ /______ or Length of Study: __________________________ □ weeks or □ months

Month Day Year

Educational Goal: _________________________________________________________________________________________

Occupational Goal or Planning: ______________________________________________________________________________

Educational Background: □ High School □ College □ University □ Other ___________________

Self-assessed Knowledge of English: □ Good □ Fair □ Poor □ None

Test Score (if any taken) □ TOEFL ______ □ GMAT _______ □ GRE ______ □ Other ( ) ___________________

Do you have a TESOL certificate? □ Yes □ No If No, would you be interested in a TESOL certificate following your course? _____

Occupational Background: __________________________________________________________________________________

Name of Company Occupation Number of Years

Fill Out The Following Information If You Are Already In The United States.

Type of Visa: ________________ Issued: _______ /_____ /______ Expires: _______ /_____ /______

Month Day Year Month Day Year

I-94 ID #: ________________ Issued: _______ /_____ /______ Expires: _______ /_____ /______

Emergency Contact: _______________________________________________________ Relationship: ___________________________

City / Country: ___________________________________________________________ Telephone #: _____________________________

I certify that the information submitted on this Application is true and correct. I understand the Application Fee is due and payable along with this completed form. If accepted by Word-Wide ESL Institute, I further understand my initial tuition, book fees and service fess (if any) are payable before my class starting date. I have read and understand WWESLI’s refund policy on Page 2 of this Application Form.

Date: ____________ /_______ /___________ Signature of Applicant: ____________________________________________________

Month Day Year

Please review this information including Desired Start and End dates (required) before forwarding to Word-Wide ESL Institute.

Before entering the United States, you will need to provide our school proof of age (copy of passport), medical insurance and a bank statement showing funds for your length of study in the USA. We look forward to welcoming you to Word-Wide ESL Institute in San Diego, California.

WORD-WIDE ESL INSTITUTE TUITION REFUND POLICY

An Application Fee of $100.00 is required to apply to Word-Wide ESL Institute (WWESLI). If you are accepted by WWESLI, you will receive a letter of admittance, and your Application Fee is nonrefundable. If you are denied acceptance by WWESLI, your Application Fee will be refunded to you along with a denial letter stating the reason for our denial of your application. You have a right to appeal this decision in writing to WWESLI within 10 days, and WWESLI will respond to your appeal and any corrections you have informed us about within 10 days after our receipt of your appeal. After a student has studied for an initial prepaid tuition period as listed on the front of this form, tuition is payable every five weeks. Additional weeks constitute a rollover enrollment under the terms of this agreement.

YOU HAVE A RIGHT TO WITHDRAW FROM A COURSE OF INSTRUCTION IN THE STATE OF CALIFORNIA:

You have a right to withdraw from a course of instruction in California and receive a refund of your prepaid tuition in accordance with California and federal laws. Please read the following WITHDRAWAL notices below for specific refund information.

All Refunds are Subject to the Following: All refund requests must be made in writing to Word-Wide ESL Institute, Admissions, 4843 Voltaire Street, Suite A, San Diego, CA 92107, or fax, US 619-222-6404, or by signed email to study@wordwide.us . The Application Fee of $100 is not refundable. Service fees or “used” fees are not refundable and are invoiced to student. Payments made through a third party, such as an Agent, are refunded to the Agent. Attendance for a partial week constitutes a week for refund purposes.

You have a right to withdraw from a course before the course begins: Amount of Refund

IF student is denied an F-1 visa, has been issued an I-20 from WWESLI, does not enter the United States and has provided WordWide written notice up to and including seven (7) days prior to the student’s scheduled start date, 100% of prepaid tuition and book fees will be refunded.* You must return the original I-20 and a copy of the SEVP denial letter to Word-Wide ESL Institute with or following your withdrawal notification. The date of withdrawal is the date WWESLI receives these documents.	100% of prepaid tuition and books, less used fees yet unpaid*
IF student is denied an F-1 visa, has been issued an I-20 from Word-Wide ESL Institute but does not enter the country and withdraws after seven (7) days from the first day scheduled, or never attends Word-Wide ESL Institute, refund is subject to service fees not yet paid and a $250 cancellation fee*	100% of prepaid tuition and book fees less used fees and $250 cancellation fee*
IF student is issued an I-20 from Word-Wide ESL Institute and enters the country but withdraws on or before seven (7) days before the start of first day scheduled, or never attends WWESLI, prepaid tuition is subject to a $250 cancellation fee.* Student will be immediately reported to SEVIS as out of status.	Tuition and book fees less used fees and $250.00 cancellation fee*

You have a right to withdraw from a course after the course has begun: Amount of Refund

IF student withdraws from a scheduled study of four weeks or less before scheduled start	No refund
IF student withdraws from a course greater than four weeks on or before the fifth day of the first week scheduled, student is entitled to a refund of tuition less a $250 cancellation fee, book fee and used fees*	Tuition minus $250 cancellation fee*
IF student withdraws from a course greater than four weeks after the fifth day of the first week scheduled, up to (60) percent of the course’s duration, the first four weeks are non-refundable. Refund is based on a pro rate of prepaid tuition for remaining weeks. Books and used fees are not refundable*	No refund of initial four (4) weeks; remaining weeks are based on a pro rata rate*
IF student withdraws from a course greater than four weeks after completing fifty (50) percent	No refund

* Service Fees / Used Fees: Word-Wide ESL Institute may contract with students for services in addition to the Application Fee, prepaid tuition and books. These fees include but are not limited to express mail delivery of student’s I-20, wire transfer fees, international or domestic credit card processing fees, airport pick up and other services, such as HomeStay. These fees are invoiced to the student, and payment for such services is not refundable. Outstanding invoices for these services may be held against tuition in addition to the $250 cancellation fee.

Refund Example: A student enrolls for one 10-week ESL Level (190 hours) and pays $1950.00 for the student’s initial 10 weeks’ prepaid tuition. The student withdraws during the third week of instruction. The pro rata refund is calculated as follows:

Student pays $1950 for 10 weeks tuition (190 clock hours), and withdrawals after class the fourth week. The first four weeks (76 clock hours), or $1170, are not refundable. The refund for the remaining six weeks’ tuition (114 clock hours) is $1170.00.

Weeks Attended	1	2	3	4	5	6	7	8	9	10
Refund Amount	$1170.00	$1170.00	$1170.00	$1170.00	$975	No refund	No refund	No refund	No refund	No refund

HOMESTAY OR ACCOMMODATION:

HomeStay Application Fee of $250 or WordWide Accommodation Fee of $175 are non-refundable.

IF a student arranges a HomeStay or other accommodation through WWESLI or directly and cancels the accommodation up to thirty (30) days before scheduled start, the $250 Application fee is non-refundable; after 30 days before start, the first week and the $250 Application Fee are nonrefundable. Refund is made within thirty (30) days after written notice is provided to the school and/or HomeStay provider, minus transaction fees incurred by WWESLI, such as international bank card fees and wire transfer fees, etc. **

** WWESLI offers HomeStays, apartments, hostels or other accommodation assistance for a non-refundable $250 fee. When booking through WWESLI, we can assist you in all instances where you may need a refund; however, HomeStays or other accommodations usually involve third-party accommodation providers, and you and WWESLI must abide by each provider’s refund policies.

A) Signature of Student: _____________________________ by signing herein, I am stating that I have read the Refund Policy and understand it in full.

Or B) ___________________________by signing herein, I have had an interpreter explain this information to me, and I understand it in full.

Name of Interpreter: _______________________________________________ Email of interpreter: ________________________________________________

Interpreter Address: _____________________________________________________ City: _____________________________ State: _________________

Zip/Postal Code ____________________ Country: _________________________ Interpreter Signature: ___________________________________