OHLA - University Placement Application - Learn English in Florida

Personal Information

Name*

First Last

Gender (male or female)*

Date of birth:*

City of origin

Country of origin

Passport number

Passport date of expiration (DD/MM/YYYY)

Contact Details

Current home address:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile Phone*

Home Phone*

Email*

Applicant's mailing address in the U.S. (If applicable)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact

Name

First Last

Relationship

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Email

University Information

Mark all applicable.

What program(s) are you wanting to apply for?*

Associate Degree
Bachelor's Degree
Master's Degree

What area do you want to study?*

When do you want to start?*

Spring
Summer
Fall

Educational History

What year did you graduate from High School?*

Did you take any time off after graduating from High School. If yes, what did you do?

Name of the High School you graduated from?

If you already studied at the Bachelor level, did you graduate?

Yes
No

If you are applying for a Master's degree program, what is the name of the university you received your Bachelor degree from?

Do you have a score for one of the following linguistic tests?

TOEFL
IELTS
Pearson
I do NOT have a score for any of these tests

Please provide the date the test was taken and the score received.

Funds

Who will finances your studies ?

Me and/or my parents will pay for it
I am sponsored by a government agency

Name of the Government Agency that will sponsor my studies.

Registering Agency

only if applicable

Name of the agency

Name of the agent representative

First Last

Agent's Email

Agent's Phone Number