The English Center
7700 Edgewater Drive
Suite 540
Oakland, CA 94621
Phone (510) 836-6700 info@englishcenter.edu
Application for Part-Time Study
The following information will be sent directly to the English Center when you press the “SUBMIT” button. Note: There is a $25 non-refundable application fee. The class
fee is due at the beginning of the session.
Non-Immigrant/International Student
(Complete only parts 1-3 and part 7.
Note: F-1 students cannot study part-time.)
(F-1)?*
Yes: No:
Immigrant/U.S. Resident Student
(Complete all parts.)
(F-1)?*
Yes: No:
Your Name:
Last or Family Name*
First Name(s)*
Middle Name
Email*
Your Address:
Street or Post Office Box*
City*
Province/State
Postal Code
Country*
Your Telephone Number:*
Country Code
Number
Date of Birth*
Month
Date
Year
Gender*
Male: Female:
Address where acceptance should be mailed (if different from permanent address)
Street or Post Office Box
City
Province/State
Postal Code
Country
Immigration Status Information
Country of Birth
Country of Citizenship
Date Entered U.S.
Month
Date
Year
Postal Code
ID Type & #:
Availability*
Day & Eve OK
Morning only
Eve only
Most Recent Work Information
Employment status:
Employed Never worked Unemployed - Last worked:
Month
Date
Most recent company name:
Position:
Supervisor’s name:
Employment dates:
Employment hours:
Hours per week:
Salary: $
/hr or $
/mo
Benefits:
Health Care
Retirement
Unemployment Insurance
Employer mailing address:
Street or Post Office Box
City
Province/State
Postal Code
Country
Phone Number
Vocational and Program Assessment
Key Occupations/Volunteering in Home Country (See oral interview notes.):
Short-Term Career Plan:
* I certify that all information provided on this form is correct and complete. Checking this box serves the same certification purpose as signing and dating a printed version of this application form.
The English Center
7700 Edgewater Drive
Suite 540
Oakland, CA 94621
Phone (510) 836-6700 info@englishcenter.edu
