Part-time English Program Application Step 1 of 5 20% NameThis field is for validation purposes and should be left unchanged.Personal InformationName* First (Given) Last (Family) PronounsFor example: She/her, He/him, They/themGender* Male Female Non-binary Country and City of Birth*Nationality*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Native Language*Address: Home CountryAddress: Home Country* Street Address City Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country TelephoneEmail* Emergency Contact NameEmergency Contact Country Code/TelephoneEmergency Contact Email Address: U.S.If you are currently living in the U.S., please provide your address.U.S. Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Postal Code TelephoneEmail Emergency Contact NameEmergency Contact TelephoneEmergency Contact Email How did you hear about ILI?* Starting DateFor how many months do you plan to study? (Tuition is $975 per month)*What date do you plan to start your classes?* MM slash DD slash YYYY What date to you plan to finish your classes?* MM slash DD slash YYYY English Level Self-AssessmentSelf-Assessment*Please select your level from the options below. ILI staff will confirm your level on the first day of the program through a grammar test, a speaking interview, and a writing sample. Beginner and A1 Elementary classes are not available without a minimum enrollment of 4 students. Beginner: I have no understanding of English and cannot ask or answer basic questions. A1 Elementary: I can understand and use basic vocabulary and short phrases in everyday situations. A2 Upper Elementary: I can engage in simple conversations and write sentences about familiar topics. (TOEFL iBT = 0-40 / IELTS = 2-3) B1 Intermediate: I can communicate effectively in most social, work, and school situations with some errors and some limitations. I can write and speak using most common grammatical structures and some academic and professional language, with some errors. (TOEFL iBT = 40-70 / IELTS = 3-4.5) B2 Upper Intermediate: I can easily communicate about familiar and unexpected topics in most situations using complex grammatical structures and appropriate academic and professional language. I can read books, write essays, and converse with independence. (TOEFL iBT = 70-95 / IELTS 4.5-6.5) C1 Advanced: I can speak, read, write and listen in collaboration with native speakers in most professional and academic situations with few grammatical errors and without strain. I can use a wide range of idioms and expressions. (TOEFL iBT 95-120 / IELTS 6.5-8.0) Writing SamplePlease write a short paragraph about yourself in English.*What do you do? Why do you want to learn English in the U.S.? What will you do in the future? If you can use the past tense, describe something from your past. The total writing sample should be between 75-100 words. If you are choosing a home-stay option, your host will receive a copy of your writing sample. Please include as much information about yourself as possible. Homestay RequestIf you request a homestay, you will be charged a non-refundable homestay search fee of $125 with your application.Homestay Preference* No, I do not wish to have ILI arrange a home-stay for me. Yes, please arrange a homestay for me during my studies at ILI ($125 non-refundable fee). I will stay with:My U.S. address is: Street Address City State ZIP Homestay NeedsA non-refundable homestay search fee of $125 will be charged with your application.How many months would you like your homestay?*Arrival Date* MM slash DD slash YYYY Departure Date* MM slash DD slash YYYY Homestay Preferences* I prefer a homestay with meals included. ($290 per week) I prefer a homestay without meals. ($165 per week) Do you smoke?*ILI cannot guarantee accommodations for those who smoke. Yes No If you have any allergies, please list them below.Can you live in a home with pets?* Cats are ok. Dogs are ok. No pets, please. Can you live in a home with young children?* Yes No Can you ride a bike?* Yes No Will you have a car?* Yes No Special RequestsIf you have any other requests related to homestay, please list them below. Do you need transportation when you arrive?If you need transportation from the airport, ILI can arrange a car to get you from Bradley International Airport, Hartford, CT (for a fee of $85) or from Logan International Airport in Boston, MA (for a fee of $200).Yes, I need transportation. Please arrange for a car to meet me at the airport and take me to my home-stay. Bradley International, Hartford, CT ($85) Logan International, Boston, MA ($200) If you want ILI to arrange transportation from the airport, you must give the following information to ILI at least two weeks prior to your arrival: Departure Airport Arrival Airport Airline Flight Number Arrival Date Arrival Time Student Health InsuranceWhat is your insurance coverage going to be?*Health insurance is mandatory. You can choose to purchase your own, or you may purchase insurance through International Student Insurance ($65 per month) through ILI. The premium will be added to your final invoice. I will purchase medical insurance through ILI ($65 per month) I have my own medical insurance and will provide ILI with proof of insurance upon arrival. Please read the following:If you have questions about the fees and policies, or if you need them translated into another language, please contact macey@ili.edu before submitting your application.Non-refundable Fees*The tuition deposit and homestay search fee are NOT refundable. Please read the full list of Part-time English Program non-refundable fees and tuition costs. Do you understand and agree to these fees? Yes No Cancellation and Refund Policy*Please read ILI’s cancellation and refund policy. Do you understand and agree to this policy? Yes No Payment of Non-Refundable Tuition Deposit and FeesTuition, homestay and insurance fees (if applicable) are due on the first day of each monthly session. One-time $150 materials fee is due on the first day of the program. Non-refundable tuition depositTotal $0.00 Payment Options* Credit Card Check (make payable to ILI) Wire Transfer Please contact macey@ili.edu for bank account details.Credit CardCard Details Cardholder Name SubmissionCommentsPlease enter any special comments you may have.By entering my name below, I confirm that I understand all the information in this application, including the fees and refund policy , and that I have read and accept ILI’s privacy policy. CAPTCHASignature* Δ