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

STEP 1: Who You Are...
Mr. (male) Ms. (female)
Date of Birth:
Full Name:	[Last (Family) Name, First (Given) Name]
Address Line 1:
Address Line 2: (if necessary)
City/State or Province:
Country:
Mail Code:
E-mail Address:
Home Phone: FAX:	(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:	Undergraduate Graduate - Major: (CSUDH requires a minimum 550 TOEFL score)
Housing Preference:	Apartment on Campus Homestay No Housing Assistance Needed
Have you attended California State University Dominguez Hills before? No. Yes. If "Yes," when?
STEP 3: When You Want to Start the Program...
Select one session from the list of sessions below: 2001 Intensive English Language Program Schedule Term Orientation Class Dates Tuition Spring A January 2-3 January 4-February 23 $1,500 per session Spring B February 26-27 February 28-April 20 $1,500 per session Summer A April 30-May 1 May 2-June 22 $1,500 per session Summer B June 25-26 June 27-August 17 $1,500 per session Fall A August 27-28 August 29-October 19 $1,500 per session Fall B October 22-23 October 24-December 14 $1,500 per session
Please also send me information on Short-Term Programs (STP): January July August
STEP 4: How to Complete Your Application...
The following materials are also required for application: This Application Form (or mail the printed version of this application form) Application Fee: $55.00 U.S. (check or money order payable to CSUDH; non-refundable; no credit cards accepted) Financial Verification*: scholarship or bank statement verifying a minimum of $7,000 U.S. dollars for studies (* For those applicants wishing to receive I-20's to obtain F-1 Student Visas for full time study only)
Send all required materials with the $55 Application Fee to the address below: AMERICAN LANGUAGE AND CULTURE PROGRAM California State University, Dominguez Hills 1000 East Victoria Street - SAC-1143 Carson, CA 90747 USA E-mail: ALCP@dhvx20.csudh.edu

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