Study

Educational Opportunities USA Application of Interest
Academic Year 2012 - 2013

Students Name: Date of Birth: MM/DD/YYYY
Sex: M F Current Class Year:
Phone Number:
Email Address:

What school did you attend?

How many years have you studied in English?

What is your current English Level?
Check one: Fluent Nearly Fluent Intermediate Beginning

Are you an Albanian Citizen?

Yes No

Why are you interested in studying in the United States?

Have you ever visited the United States Before?

Yes No

If yes, where have you visited?

Have you ever applied for a visa to the United States?

Yes No

If yes, was your visa approved?

Yes No

Do you know of any non - family members in the US who would be interested in hosting you for an academic year? (Note: Uncles, aunts, cousins and other relatives are considered family members.) This is only for informational purposes. Knowing or not knowing a potential host-family does NOT disqualify you from participating in the program) Yes No

If yes,

Name of contact in the US:

Address of Contact in the US:

Are you interested in attending a private school in the United States? Note: Private school tuition fees are in addition to the EOUSA program fees Yes No