Last Name* First Name* E-mail*

Address

City State ZIP Code Telephone

High School Attended

Address

Did you graduate/complete high school? Yes No     GED GED Year

If you completed High School, please indicate the month and year.  Year Graduated

Interested in Applying for a change of Status (School Visa) Yes No

What term would you like to enroll in? Fall Spring Summer Year

Program that you would like more information about:
(Programs and courses qualify for Form I-20 approvals.)

PROGRAM / COURSES (Hours) (With ESL - Check one) ESL-Intensive Accounting (1920) ESL-Medical Office Assistant (1920) ESL W/Computerized Applications (1536) Comprehensive ESL (1152) Intensive ESL (768) English 100 (288) English 200 (288) English 300 (288) English As A 2nd Language (ESL) 100 (384) English As A 2nd Language (ESL) 101 (384) English As A 2nd Language (ESL) 102 (384)

REGULAR PROGRAMS (Hours) (Check one) Computerized Accounting Assistant (1536) Medical Administrative Assistant (1536) Accounting W/Computer Applications (1152) Medical Office Assistant (1152) Computerized Applications (768) Computer and Design Application (CDA) (1152) Computer Networking and Security (656)

Who do we contact in case of emergency?

Emergency Name
Emergency Relationship
Emergency Telephone
EmergencyAddress

New York Institute of English and Business provides equal opportunity for all qualified applicants, and prohibits discrimination on the basis of race, color, religion, sex, sexual orientation, age, national or ethnic origin, the physically handicap, marital, parental or veteran status, in the operation of its educational programs, courses, activities and in the recruitment of qualified personnel.