Student ID number
English Language Institute Registration Form
Name: _____________________ ________________ ______ E-Mail: ______________________
Last
First
Middle
Mailing address: ________________________________ ____________________ ________
(US address)
Tel: (
number and street
City
) ____________________
Cell: (
_______________
State
Zip
) _________________
Permanent address: ____________________________________________________________________________
(Parents / International if different from your mailing address)
Tel: ___________________________________________________
country code if any
area code
number
Emergency contact: _____________________________________________________
Tel: (
) _______________ Cell: (
) _______________
Date of Birth: ________________________
Month
Day
Sex:
Male / Female
Year
Ethnic background (optional):
1 (Black Non-Hispanic) 2 (Asian or Pacific Islander) 3 (Hispanic) 4 (Amer-Indian Alaskannat)
5 (White-Non-Hispanic) 6 (Other)
Are you a U.S. citizen?
Yes / No
If not a U.S. citizen, indicate status (circle one): Student (F-1) Tourist (B1/B2) Diplomat
Work Visa (H1/J1) Refugee Permanent Resident
Other Non-Immigrant Visa (specify) __________
Country of citizenship: _______________________ Native language: ____________________________
How long have you been in the US? ___________________________________________________________
What is your highest level of education (circle one)? High school college/university
Graduated? Y / N
graduate school
Major (college/university/graduate school): ______________________________
Name of school ___________________________________________ City _____________ Country ____________
My educational goal is: _____________________________________________________________________
How did you hear about the English Language Institute programs? (Please check one)
Friend or relative who studied at ELI __
Mailing __
Internet __
El Aguila ad __
Friend or relative who attends Pace University ___
Posted announcement __
ELI Use:
(
(
) Banner ( ) CELT score ( ) Contact Info (
) contact student ( ) copy to folder
) Registration paper
(
) Procedure
ENGLISH LANGUAGE INSTITUTE WESTCHESTER
PAYMENT POLICIES
Intensive Program
2015 – 2016
GENERAL INSTITUTION FEES: Please note that in addition to cour se tuition fees, Pace Univer sity charges a General Institution Fee (GIF) each time a student registers, and it is non-refundable. All Pace
students must pay the GIF. This fee is for the use of Pace Univer sity facilities including the fitness
center, library, computer labs, multi-media lab, etc. The GIF is calculated as follows:
Contact hrs/wk
2-6 hrs/wk
8-10 hrs/wk
12-16 hrs/wk
18 or more hrs/wk
3- or 4-week GIF
$35.00
$51.00
$69.00
$99.00
6 - or 7-week GIF
$ 70.00
$ 103.00
$ 138.00
$ 198.00
REFUND POLICY: You must r egister for a 3-, 4-, or 7-week course. There will be no reduced fee or
refund for classes that you do not attend. If you wish to withdraw from (drop) a course, you must submit a
“Change of Schedule” form to the Office of Student Assistance (OSA). If you do not submit this form,
you will not receive a refund and you will receive an F for the course at the end of the semester. Refunds
are calculated as follows. If a student withdraws:
6-week course
7-week course
prior to and during first week of term
100% refund
100% refund
during the second week of term
25% refund
50% refund
after the second week of term
no refund
no refund
3-week course
4-week course
prior to first day of term
100% refund
prior to first day of term
100% refund
first day of term
50% refund
during first week of term
50% refund
second day of term and thereafter
no refund
after first week of term
no refund
Student refunds take approximately 14 business days from the date the credit appears on the account.
COURSE CHANGES: Dur ing the fir st week of class, students may exchange one cour se for another or change levels at no extra charge, provided the added course does not have more hours of instruction
than the dropped course. If the added course has fewer hours of instruction than the dropped course, refund of tuition (difference between old course and new course) will follow the policy outlined above. To
change courses or levels, go to the ELI Assistant Director to get permission. If the course is approved, the
Assistant Director will fill out and sign a “Change of Schedule” form. Then take the form to OSA. There
is no fee for changing levels if the level change is approved by the ELI Assistant Director. After the second week of class, students may not change courses.
PAYMENT TERMS: If you ar e a 3-, 6-, or 7-week student, full payment is due at the time you register. You may pay with check, traveler’s checks, or money order. Make checks and money orders payable
to Pace University. Be sur e to include your student name. A late fee of $110 will be assessed if full
payment is not received within 10 business days of the start of the course.
Note: http://www.pace.edu/sites/default/files/files/OSA/Fall-2015-Information-Guide-Version_1_1.pdf