Evening Program Online Application

Thank you for your interest in applying for the Community ESL Evening Program. Please complete the form below and click “Submit” at the bottom of this page.

Remember to send all required documents and the tuition deposit ($25) immediately so that we can process your application!

*(denotes required field)

First Name: *

Middle Name:

Last Name: *

E-Mail Address: *

E-Mail Address again: *

Please enter your E-mail Address a second time.

Gender: *

Date of birth: *

ELI applicants must be at least 17 years old.

Country of birth: *

Country of citizenship: *

Contact Information

Street address: *

City: *

State: *

ZIP code: *

Country: *

Telephone: *

Do you have a US Social Security Number (SSN)?

Do you have an SSN? *

If so, what is your Social Security Number?

SSN:

Are you an Au Pair? *

If you are an Au Pair, what is the name of your agency?

Au Pair agency name:

Are you a UD student or employee? *

If so, please enter your student ID number.

UD Student ID#:

Session Dates

Select all sessions that you wish to attend.

Dates: *

March 7/2012 to May 16/2012
May 23/2012 to July 30/2012

Note: Classes will not be held during holidays or at any time when the university is closed (see calendar).

Course Selection

Which course do you wish to take?

Course selection: *

Billing Information

Are you sponsored by a company/organization?

Are you sponsored?: *

If yes, should we give the bill directly to you?

Please choose: *

If you wish us to give the bill to your sponsor, please give us the address so that we know where to mail the bill.

Name of sponsor/company:

Sponsor contact person:

Sponsor address:

Sponsor City:

Sponsor State:

Sponsor ZIP code:

Sponsor Telephone:

Email address:

Note: If a sponsor will be paying for your studies, then you must submit an official letter of sponsorship detailing fees covered (tuition/books). This letter can be sent to us by email at ud-eli@udel.edu or by fax at 302-831-6765.

Tuition Deposit

The ELI requires a $25 tuition deposit (which is applied to your tuition fee and is nonrefundable within 30 days of your session’s start date). These fees are due with your application. Please download and complete our Credit Card Authorization Form to make this payment. Please send this form to the ELI by fax at 302-831-6765.

Signature (type your name here): *

Evening Program Online Application

Session Dates

Course Selection

Billing Information

Tuition Deposit

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