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START DATE * MM / DD / YYYY
Please tell us the date you would like to begin study. Your start date MUST be a MONDAY.
Name * First Last
Please type your first name FIRST then your FAMILY name.
Gender *
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Email *
Country of Birth *
Must be between 3 and 25 characters. Currently Used: 0 characters.
Country of Citizenship *
Must be between 3 and 25 characters. Currently Used: 0 characters.
Permanent Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number *
Age *
Where are you now? *
Immigration Status *
How did you hear about IIC?
Emergency Contact Information
Name * First Last
Relationship *
Email *
Phone Number *
IIC ESL Program Refund Policy

PLEASE READ CAREFULLY. All ESL courses are individualized and begin on the date on the invoice. Tuition deposits or full tuition payments will not be refunded once your course has begun. Deposits and fees are non-transferable from person to person. *If you would like a tuition deposit refund, you must request the refund in writing by emailing eslinfo@iic.edu no less than 1 week before the start date. Remember that the application fee is non-refundable.
Signature

By checking "ELECTRONIC SIGNATURE," you understand and will abide by the terms of the IIC ESL Refund Policy, agree that everything in this application is true, and authorize IIC to process any paperwork regarding this application. Your signature also certifies that you have read, understood, and agreed to your rights and responsibilities as a student explained in the IIC Student Handbook.
Signature Confirmation *
ELECTRONIC SIGNATURE
Do Not Fill This Out

Wufoo

Emergency Contact Information

IIC ESL Program Refund Policy

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