Texas Intensive English Program Evening Courses Application
APPLICATION FORM
To register for a Texas Intensive English Program (TIEP) evening course, print and complete this application form and bring it to 1103 West 24th Street during registration. Also bring the course tuition, testing fee, and your passport or other government-issued photo ID:
Placement Test
| Please select a session by checking a box below | |||
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| Session | Session Dates MM/DD | Registration & Placement Test | |
| Spring 2009 | 2/3- 4/16 | 1/27 (9 am - 7 pm) 1/28 (9 am - 4 pm) |
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| Summer 2009 | 6/2 - 8/6 | 5/26 (9 am - 7 pm) 5/27 (9 am - 4 pm) |
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| Fall 2009 | 9/15 - 11/19 | 9/8 (9 am - 7 pm) 9/9 (9 am - 4 pm) |
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Payment is due at the time of registration and may be paid by check, money order, Visa, MasterCard or Discover card.
Please indicate the course you would like to attend:
- Conversation and Pronunciation Skills:
Beginning Intermediate Advanced
- Writing and Grammar
High intermediate-Advanced
Family Name _____________________________, First Name _______________________ Local Address ___________________________________________ (zip code) __________ Daytime Telephone _____________________ E-mail ______________________________ Sex: M F Date of Birth (month / day / year): ________ / ________ / ________ Permanent Address: _________________________________________________________ _________________________________________________________ _________________________________________________________ Nationality __________________________________ Visa Status ____________________ Emergency Contact: Name: ______________________________Phone: ________________ Last enrolled at TIEP: Semester & Year: ____________________ Course: ____________ TUITION: Payment of tuition is due in full at the time of registration. Tuition may be paid with cash, a check, a money order, or Visa/MasterCard/Discover. Tuition includes books and materials. APPLICATION FEE: A one-time, non-refundable application fee of $25 is required for individuals enrolling in a TIEP evening course for the first time. Continuing students do not pay this fee again. DISCOUNT: A 10% discount is available for continuing students who enroll in an evening course within six months of prior enrollment provided the application form is received and tuition is paid in full by the registration deadline. REFUND POLICY: I understand that:
Applicant’s Signature _______________________________________ Date ______________ Evening Course Supervisor’s Signature __________________________ Date ______________
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