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Preparation for an American University Program Application Form
 Phone: 631-287-8318
 Fax: 631-287-8118 
 English Language Institute
 Southampton Graduate Campus
 239 Montauk Highway; Southampton, NY 11968 USA
 
  Applicant Info
First Name
 
MI
 
Last Name
 
Street
 
City
 
State
 
Zip
 
Phone
 
Fax
 
Email
 
Gender
Male
 
Female
 
Date of Birth
 
Country of Birth
 
 
Educational Background
 
 
 
 
Parent/Sponsor's
First Name
 
MI
 
Last Name
 
Street
 
City
 
State
 
Zip
 
Phone
 
Fax
 
   
  I will attend the following semesters
 
Spring 2002 ($6,950)
 
Intersession I ($625)
 
Summer 2002 ($5,985)
 
Summer Intersession 2002 ($375)
 
Fall 2002 ($6,950)
 
Intersession II 2003 ($875)
 
Full Year ($19,885)
 
Full year including Intersessions ($21,760)
 
Tuition fees can be paid by check, money order, traveler's checks, or credit card. Tuition is due upon arrival at Southampton Graduate Campus.
Please attach a separate sheet describing why you would like to be a part of the Preparation for an American University Program.