Application form to begin the application

process at the English Language Center of the

University of Denver

1. ELC Eligibility Criteria

The English Language Center requires that all applicants have at least a high school diploma
and some knowledge or prior study of English before they begin.

Please answer the following questions confirming your eligibility to apply.

I think my level of English is:

0 - True Beginner (No English)

1 - Beginner (Words, simple sentences, classroom, family and home)
2 - Intermediate (Sentences, paragraphs, short conversations)
3 - Advanced (Paragraphs, essays, presentations, discussions)

Will you graduate high school before you start at the English Language Center?
Yes No

What is the name of your high school? _________________________________________

Will you be at least 18 years old when you start your studies at the ELC?
Yes No

Do you want to authorize a third party (friend, family, agent, etc.) to communicate with ELC staff
on your behalf regarding your application?
Yes No
2. Biographical Information

NAME

First (Given) Name: ____________________________________________________________

Last (Family) Name: ___________________________________________________________

Preferred Name/Nickname(optional): ______________________________________________

Previous Last (Family) Name (optional): ____________________________________________

ADDRESSES

Permanent/Home Address. This is your permanent, legal residence, and should not be a P.O. Box.

Street Address: _______________________________________________________________

City: _________________________________ State:_________________________________

State: __________________________ Country: _____________________________________

Do you want to receive the document I-20 at your Home Address mentioned above?

Yes No

If your answer is “Yes, please continue with next section. If your answer is “No” please specify mailing
address below

Mailing Address. This is the address where you will receive the welcome package and I-20 from the
University

Street Address: _______________________________________________________________

City: _________________________________ State:_________________________________

State: __________________________ Country: _____________________________________

 CONTACT INFORMATION

Email: _____________________________________________________________________

Phone Number: _____________________________________________________________

Cellphone Number: __________________________________________________________

BIOGRAPHICAL INFORMATION

Diversity Statement: The University of Denver values the diversity of our student body. We collect these
data as one measure of our diversity progress and to comply with federal law and other required external
demographic reporting. With exception of the mandatory Birthdate field, we request your voluntary
cooperation in identifying yourself as closely as you can with the racial and ethnic reporting categories
below. If the offered categories do not describe you accurately, please select the closest option(s) listed.
The information you provide will not be used in any discriminatory manner. Thank you for your
assistance.

Gender: Female Male

Birthdate(mm/dd/yyyy): _________/___________/__________________

Birth Country: ______________________________________________________________

Birth City: _________________________________________________________________

Native Language: ___________________________________________________________

CITIZENSHIP INFORMATION

Primary Citizenship: __________________________________________________________

 RACE/ETHNICITY

Colleges and universities are asked by many groups, including the federal government, accrediting
associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students
and employees. In order to respond to these requests, we ask you to answer the following two questions

Do you consider yourself to be Hispanic or Latino? Yes No

Regardless of your answer to the prior question, please check one or more of the following groups in
which you consider yourself to be a member

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific

White

3. Immigration and Visa Information

Country of Legal Residence: __________________________________________________________

Option A: You will be considered an international student (non-resident alien/non-permanent

resident) for admission purposes if one of the following statements applies to you:

• You are not a United States national, permanent resident, or citizen.

• You are currently in the United States on an F-1 or J-1 student visa.
• You reside in the United States and hold other non-immigrant visas (E-2, H-2, or L-2, for
example).

Option B: You will be considered a domestic student (United States citizen/permanent resident)
for admission purposes if one of the following statements applies to you:

• You are a permanent resident of the United States (you will be asked to please upload a
copy of your permanent resident card or "green card" later in the application).
• You are a naturalized United States citizen.
• You hold dual citizenship with the United States and another country.
• You are a United States citizen, independent of your current address.
4. Program Information

When do you plan to start your studies at the English Language Center?

Year: _______________

Quarter:
Winter (January - March)
Spring (March - May)
Summer (June - August)
Fall (September - November)

Have you applied or are you currently applying for English conditional admission to a degree
program at the University of Denver?
Yes No

Have you applied or are you currently applying for English conditional admission to a degree
program at the University of Denver?
Yes No

Who will pay for your studies at the English Language Center?
You
A family member
A person (not yourself or a family member)
Sponsor: a company
Sponsor: an embassy
5. ELC Academic Record
Are you transferring from another English language program in the U.S.?
Yes No
What is the highest level of study that you have completed?
I am a high school student
High School diploma
Associate's degree
Undergraduate (Bachelor’s) degree
Graduate (Master’s/Doctorate) degree

The University of Denver offers bachelors, masters, and doctoral degrees as well as certificate
programs. Once you successfully complete the English Language Center, would you be
interested in pursuing any of the following degrees or a certificate program?
Yes, I am interested in pursuing a Bachelor's degree
Yes, I am interested in pursuing a Master's degree
Yes, I am interested in pursuing a Doctoral degree
Yes, I am interested in pursuing a Certificate program
No, I am not interested in pursuing a degree at DU

Language Proficiency

Have you studied English in a school or with a teacher in the past?

Yes No
For how long have you studied English?
Less than 1 year
1 - 2 years
3 - 5 years
More than 5 years
What English assessment tests have you taken?
I have not taken an English proficiency test.
Cambridge English Language Assessment (CELA)
DuoLingo
International English Language Testing System (IELTS)
Pearson Test of English (PTE)
Test of English as a Foreign Language (TOEFL)

6. Written Responses
Please introduce yourself.

Why do you want to study English?

6. Additional Information
7. Disciplinary History
*Have you ever been or are you currently under probation, suspension, or dismissal from any
educational institution you have attended for conduct or disciplinary reasons?
Yes No

*Have you ever been convicted of or pleaded guilty to a criminal offense other than a minor
traffic violation, or are there criminal charges pending against you at this time?
Yes No

8. Signature
Equal Opportunity Statement
The University of Denver is an Equal Opportunity Institution. It is the policy of the University not to
discriminate in the admission of students, in the provision of services, or in employment on a person's
race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, gender
expression, genetic information, marital status, or veteran status. The University complies with all
applicable federal, state, and local laws, regulations and Executive Orders. Inquiries concerning
allegations of discrimination based on any of the above factors may be referred to the University of
Denver, Office of Equal Opportunity and ADA Compliance, Mary Reed Bldg., Room 422, 2199 S.
University Boulevard, Denver, CO 80208. Phone (303) 871-7436.

Signature of Applicant
Your electronic signature indicates your acceptance of the following: I understand that this application and
all credentials included for my admission file are confidential and become the property of the University of
Denver. These documents will not be returned, copied, or released to any person(s) or myself. I certify
that the information given in this application is true and complete without evasion or misrepresentation. I
understand that willful omission, falsification, or incomplete statements within this application may result in
denial of admission or dismissal.

In place of your signature, please type your full legal name:

Student’s Name

Today's Date