Application for Admission (On-Line Registration Form)

Please fill out the following form (Steps 1-4) in order to apply for admission to the American Language and Culture Program.
Use the SUBMIT Application button to send your completed form to us.

STEP 1: Who You Are...
Mr. (Male) Ms. (Female)
Date of Birth:

Example: January 31, 1982 = 01/31/1982
MM/DD/YYYY = Month/Day/Year

Full Name:

[Last (Family) Name, First (Given) Name]
Address Line 1:
Address Line 2:
(if necessary)
City, State or Province:
Mail Code:
E-mail Address:

Home Phone:


(include Country/City Code)

STEP 2: What Type of Program You Want?
Country of Citizenship:
Native Language:
VISA Status:
(Check one)
Requesting an I-20 to enter the U.S. on an F-1 Student Visa
Transferring an I-20 from another school in the U.S.
I-20 Not Necessary (e.g. resident alien, U.S. Citizen, etc.)
Conditional Admittance:

Conditional Admission Requirements

I would like to receive information and application materials to apply for:

Intensive Certificate Programs (ICP) and Study Abroad America
Undergraduate Programs (Bachelor)
Graduate Programs (Master)

The Major I am interested in is:

CSUDH requires a minimum 61 IBT TOEFL score or 5.5 IELTS score for undergraduate admission and 71 IBT TOEFL or 6.5 IELTS score for graduate admission.
A separate $55 University application fee required to process university applications.

Housing Preference:
Apartment on Campus No Housing Assistance Needed
Homestay (Non-University)

All students must apply for housing well in advance of arrival.
Failure to do so may place the student on the housing wait list.

Where did you hear about California State University Dominguez Hills?
ALCP Website Agency Friend/Family
ALCP Student Language Guide
Language Website Internet Search Other

STEP 3: When Do You Want to Start the Program?
Select one session from the list of sessions below:

2012-13 Intensive English Language Program Schedule and Fees
Class Dates
Tuition *
A January 7 & 8 January 9 – March 1 $2,200 per session
B March 4 & 5 March 6 - April 25 $2,200 per session
Class Dates
Tuition *
A May 6 & 7 May 8 - June 27 $2,200 per session
B July 1 & 2 July 3 - August 22 $2,200 per session
Class Dates
Tuition *
A August 26 & 27 August 28 - October 17 $2,200 per session
B October 21 - 22 October 23 - December 12 $2,200 per session

Please also send me information on Short-Term Programs (STP):
(Available Year Round by request)
STEP 4: How to Complete Your Application...
The following materials are required before the application is complete:

Submit this On line Application Form (or mail the printed version of this application form.)

Insurance Requirment Goverment regulations require foreign students to obtain insurance to be on the campus.
This insurance must to be obtained from the ALCP program during the application process or when you arrive on campus.

Application Fee: $100.00 U.S.D. I-20 can only be issued after the application fee payment has been received. (check or money order payable to CSUDH; non-refundable; no credit cards accepted on-line) This on-line application cannot be processed without this fee.

Financial Verification*: Scholarship or bank statement verifying a minimum of $8,000 U.S. dollars for language studies.
Conditional and regular university admissions require a separate financial statement.
* For those applicants wishing to receive I-20's to obtain F-1 Student Visas for full time study only.


  • Express Mail ($100): Due to the variance between the mail systems of each country, delivery of I-20's by ground mail can be problematic. I-20's not shipped by express mail may not be re-issued if lost or stolen.
    Re-issued I-20's may also be re-charged the $100 application fee as well.
  • Campus Housing Application ($30): Students can only reserve housing in advance of arrival by completing and submitting the Housing application form.


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