FIU - ELI - COP Registration Form

Last Name (Primary Family Name) *
Second Last Name (If Applicable)
First Name *
Middle Name
Profile Picture *

Attach Files
E-Mail *
Mobile Telephone (Ex.: 305-321-4567) *

If this number is outside the U.S., please include the Country and City Code.
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Date of Birth Date of Birth * / MM / DD YYYY
Country of Birth *
Country of Citizenship *
Current Status (Not Required)
How did you hear about our program? *
Term *
Course Selection: 1st and 2nd Choices (Only select one option if that is your preference.)

Course Selection: 1st and 2nd Choices (Only select one option if that is your preference.) 1. General English 2. General English 1. Accent Reduction 2. Accent Reduction
Course Selection: *

Course Selection: General English Accent Reduction
Comments:
Terms and Policies (Please read carefully.)
• I understand that after the first day of class I cannot request a change in schedule. • I understand that the first day of class is the last day for me to request a refund of 80% of my tuition. • The Registration Fee is not refundable. • ELI is not responsible for collecting nor refunding any fees paid to the University Bookstore and/or the Parking and Traffic Department. • All tuition refunds must be requested in writing and given to the person in charge of registration. • ELI is not responsible for any parking tickets or citations issued to students. • ALL vehicles parking on-campus are required to have a valid parking permit or be parked in metered parking. • I affirm that the information provided on this application is accurate and true and I have read and understood the payment and refund policies.
Do you accept the terms and policies listed above. *

Do you accept the terms and policies listed above. Yes, I accept the terms and policies listed above.
By signing below, you affirm that the information you have provided is true and accurate and that you agree to the terms and policies.

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Date Date * / MM / DD YYYY