APPLICATION FORM

Street Address:

City:

Provence:

Street Address:

City:

Provence:

Name:

Relationship to student:

Phone Number:

Email:

DOCUMENTS REQUIRED (ORIGINALS)

PERSONAL INFORMATION

The applicationApplication fee $100 (enrollment with TALK required)

$1000 college/university depositOne-to-one university consultation and placement service(South Florida only – inquire for details)

Bank letter with letter of support (attached form)

O�cial transcripts with translations from allsecondary and post-secondary institutions attended2 letters of recommendation1 passport-sized photo300 word personal statement (if able without help)Passport copy

Given Name:

Family Name:

Middle Name:

Previous Name (if any):

Date of Birth (MM/DD/YYY): __________ /__________ /___________

Place of Birth (City/Country): _____________________ /_______________________

Phone Number:

Email Address:

Mother’s / Guardian’s Name:

Phone Number:

Father’s / Guardian’s Name:

Phone Number:

Emergency Contact:

Permanent Home Country Address:

Mailing Address:

Postal Code:

Country:

Postal Code:

Country:

Gender: Female Male

Secondary Schools Attended. Name of School/City & Country/Dates Attended________________________________________ /____________________ & ____________________ /________ to _________________________________________________ /____________________ & ____________________ /________ to _________________________________________________ /____________________ & ____________________ /________ to _________Date of Graduation from Secondary School (MM / YYYY) __________ /__________

Undergraduate Colleges/Universities Attended (if any). Name of Institution/City & Country/Dates Attended________________________________________ /____________________ & ____________________ /________ to _________________________________________________ /____________________ & ____________________ /________ to _________________________________________________ /____________________ & ____________________ /________ to _________Date of Graduation from University (if applicable) (MM/YYYY) __________ /__________

Post-Graduate Universities Attended (if any). Name of Institution/City & Country/Dates Attended________________________________________ /____________________ & ____________________ /________ to _________________________________________________ /____________________ & ____________________ /________ to _________Date of Graduation from University (if applicable) (MM/YYYY) __________ /__________

Test Information. Name of Test / Score / Date Taken (MM/DD/YYYY)TOEFL __________ / __________IELTS __________ / __________SAT __________ / __________GRE __________ / __________GMAT __________ / __________

Have you ever had a serious injury or illness? Yes NoIf yes, please explain

Do you have any special needs that the institutions should be aware of? Yes NoIf yes, please explain

List all activities you have been a part of in school/college/university

List of any honor received

UNIVERSITY/COLLEGE INFORMATION

EDUCATIONAL BACKGROUND INFORMATION

University/College applying to:

Intended major:

Degree Level: Associate’s Bachelor’s Master’s Certi�cate

Term: Fall

For undergraduate (associate’s and bachelor’s): First time student Transfer student

Winter Spring Summer 20___

The undersigned hereby gives to TALK International, its colleges, universities, o�cers, employees, agents, and host families full authority and permission to take whatever action they feel is reasonably warranted under the circumstances, and to act as agent of the undersigned student and parent/guardian, regarding the named student’s health and safety. This authority and permission includes, but is not necessarily limited to, the following: rendering or ordering medical treatment; the giving of medication; and any examinations, X-rays, anesthetic, medical or surgical diagnosis or treatment or hospital care, if and as deemed necessary. The under-signed understands that a reasonable attempt will be made to contact the undersigned parent/guardian before any action is taken. The undersigned agrees to be �nancially responsible for all medical attention so authorized or ordered during the student’s attend-ance at the college or university. The undersigned represents that the named student has no medical restriction that limits his/her full participation in the programs and activities at the college or university, except as disclosed in any writing attached to this document. Permission is given for the student to participate in all activities o�ered at the college or university, except as restricted in any attached writing. To the fullest extent permitted by law, the undersigned hereby releases TALK International, its college and university partners, o�cers, employees, agents, and host families from all liability, and waive and release all claims, related to or arising from such decisions or actions as may be taken under the authority of this document.

*My signature above authorizes TALK International to release academic records and immigration status information to the college or university, my sponsor, educational agency, and/or parents. I decline to authorize release of any information*Students under the age of 18 must also have parent/guardian’s signature.

RELEASE AND WAIVER SIGNATURES

“I verify that to the best of my knowledge all of the statements on this form are true.”

Student Name (Printed):

Date of Birth (MM/DD/YYYY) __________ /__________ /__________

*Student Signature: ____________________________________________

Date of Signature (MM/DD/YYYY) __________ /__________ /__________

Parent/Guardian Signature: ______________________________________

Date of Signature (MM/DD/YYYY) __________ /__________ /__________

TALK International Global Headquarters2455 East Sunrise Boulevard, Suite 200 Fort Lauderdale, FL 33304Phone: +1 954 565 8505 • Fax: +1 954 565 8718E-mail: admissions@talk.edu • www.talk.edu/intl