Application for Admission

Print and mail this application to:

English Language Institute Visa Office at Queens College, Kiely Hall, Room 111

65-30 Kissena Boulevard, Flushing, New York 11367-1597 USA.

NOTE: Admission to the English Language Institute does not imply admission to any division of Queens College.

Please print or type:

Family Name:_______________________    Given Name:__________________________

I am interested in attending the following semester:     Spring___  Summer___  Fall___

I am a:  Male ___    Female___   Date of Birth: _______ Country of Birth: _______________

Country of Citizenship:______________________________________

Home Address in Native Country:______________________________________

Marital status: __________     Name of Spouse (If Married):__________________________

Number of Children (If Any):_____     Ages of Children (If Any): _____    _____    _____

Will spouse accompany you to U.S.A.?     yes_____     no_____

Will children accompany you to U.S.A.?     yes_____     no_____

Secondary Schools Attended:

Colleges, Universities, and Professional Schools Attended:

I have enclosed a money order for U.S.$80, payable to Queens College, in payment of my 

nonrefundable application fee.

An Affirmative Action / Equal Opportunity Institution

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