New Student Application

Student Application

I. Required Information

Please select the center you wish to attend below:

The INTERLINK program at Valparaiso University is no longer accepting applications. Please choose another.

Campus

Expected start of INTERLINK studies:

mm/yy

How many terms/sessions do you expect to study at INTERLINK?

Where did you first hear about INTERLINK?

Referral Source

If Agent, please name:

If Other, referral source:

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First Name

Last Name

Home Phone

Cell Phone

Fax Number

Country of Birth

Country of Citizenship

Birth Date

Gender

Address

Do not leave any section blank. If there is no State, Province, or Postal Code, write “none.”

Permanent Address

Permanent Street Address

Permanent City

Permanent State

Permanent Zip Code

Permanent Country

Mailing Address

Mailing Address is Same as Permanent

Yes No Not Selected
If not same as permanent, enter mailing address below.

Mailing Address

Mailing City

Mailing State / Province

Mailing Zip Code

Mailing Country

Emergency Contact

Contact Name

Relationship

Home Phone

Cell Phone

Work Phone

Fax Number

II. Academic Information

What do you plan to do after you study at INTERLINK?

If other

Highest education level completed:

Your field of study (major):

Standardized English test

(Optional)

Name of test:

Test Score:

Date:

Rank your English Ability

Speaking:

Listening:

Reading:

Writing:

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Are you transferring from another ESL program in the U.S.?

Yes No Not Selected

Have you studied in US before?

Yes No Not Selected

If yes, name of program:

Address of program

Rank housing options in order of your preference

INTERLINK can only guarantee housing availability in on-campus residence halls (dormitories).

Housing Option Preference 1st Choice

Housing Option Preference 2nd Choice

Housing Option Preference 3rd Choice

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Do you have any physical disability or health problems that will require special assistance

Yes No Not Selected

If yes, please explain

Who will finance your education in the US?

If other, please specify:

Supporting Documents

If you have these documents ready, please attach them here.
If you do not have these document ready, you can submit them later in your application process.
Click "Affidavit" at the bottom of the Student Application Process page to download the financial support affidavit form.

Transcripts

Official Financial Support Affidavit

Official Bank Statement

Photocopy of passport

III. Family Members

You only need to complete this section if family members
will be accompanying you to the United States.

Marital Status

If married, will your spouse accompany you?

Yes No Not Selected

Do you have children?

Yes No Not Selected

If yes, will your children accompany you?

Yes No Not Selected

How many children will accompany you?

Signature & Date

Applicant's or Sponsor's Signature

App Submission Date

I understand that upon admission to INTERLINK I must abide by the rules of the Center and University. I, and/or my sponsor, will be fully responsible for the cost of my studies while at INTERLINK. Further, I authorize release of my credentials and of my medical records for medical and insurance purposes; I also authorize treatment of any illness or injury by qualified health personnel during my attendance at INTERLINK.