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Application – ICC Student

Given Name / First Name*
Name as it appears on your passport (in English letters)
Family Name / Last Name*
Date of Birth*
You must be 18 years of age before your first day of class.
MM slash DD slash YYYY
Gender on Passport*
- Female
- Male
- Other
Country of Citizenship*
Which country issued your passport?
Country of Birth*
In which country were you born?
City of Birth*
What is / will be your visa type?*
- F-1 Student
- B1/B2 Tourist
- Visitor Stamp (ESTA)
- F-2
- Other
What is your visa type?*
If you have a green card or if you are a US citizen, please note that here.
Are you transferring to ALPS from a school in the USA?
- Yes
- No
Have you previously studied at ALPS?
- Yes
- No
Medical Insurance
$175 per 4-week session if you buy it from ALPS. Medical insurance is required for all students with F-1 visa status, but if you buy your own medical insurance elsewhere, this fee is not charged.
*
- I will pay for the medical insurance offered through the school.
- I have purchased medical insurance elsewhere and I will not buy my medical insurance from ALPS.
Which course will you attend?
Full-time Courses*
Part-time Courses (Not for F-1 student visa)*
Course Selection*
Select an option - Academic Intensive English 18*
Select an option - Academic Intensive English 20*
Select an option - Academic Super Intensive English*
How long will you study?*
How many weeks?
When do you want to begin classes?*
When do you want to begin classes?*
ALPS has official start dates every 4 weeks, but you can start class on most Mondays.
MM slash DD slash YYYY
What are your English goals?*
Please briefly describe the goal of your study. Why are you studying English?
Email*
Enter Email Confirm Email
Phone*
Home Country Mailing Address
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing Address in the USA (if known)
Address
Same as above

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact
Whom should we contact in an emergency?
Emergency Contact Name*
First Last
Emergency Contact Email*
Phone*
Consent and E-Signature
Consent*
I hereby apply for admission to ALPS Language School.
I certify the statements I have made on this online application are correct and complete. Further, I have read and understood the cancellation and refund policy and I agree to make payment of all due amounts.
First and Last Names*
Today's Date*
MM slash DD slash YYYY
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Are you ready to join?

Questions?

Telephone: +01-206-720-6363
info@alps.edu
WhatsApp: +1-206-536-4152
Line (Click for QR Code)
KakaoTalk ID: alps.language.school

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430 Broadway E
Seattle, WA 98102
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