• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Only fully completed, legible applications are processed. All documents must be in English. Complete the following sections:

1 Personal Information

2 Program Information

3 How to Apply for an F-1

Student Visa

4 Transfer Student

(if applicable)

5 Payment

6 Emergency Contact

7 Student Survey

8 Student Signature

9 Submit ALL Supplemental Documents

for the program of your choice

NOTE: In order to reserve a space in the program, you

must meet all admission requirements and submit

payment for the following fees:

n Application Fee (one-time, nonrefundable)

n Program Fee

n Student Services Fee

471-Winter-2017 (11/16)

PLEASE SUBMIT TO:

2160 KERR HALL, UCSB, SANTA BARBARA CA 93106-1110 n (805) 893-4200

APPL[email protected] n EXTENSION.UCSB.EDU

Advanced

English

Program

(AEP)

University

Immersion

Program

(UIP)

UIP

Summer

6-week

Graduate Studies

Preparation

Program (GSPP)

Teaching English

to Speakers of

Other Languages

(TESOL)

Application/Enrollment in ISP

• • • • •

Minimum age 18

• • • • •

Copy (readable) of passport page clearly showing your name, date

of birth, and photograph

• • • • •

Proof of funding

• • • • •

Required for students under age 19 at time of program start date:

Hepatitis B Immunization record (translated into English)

• • • • •

Admission Requirements

Proposed list of courses for study at UCSB

• •

Completion of minimum number of course units

12 8 to 12 6 to 12 12 10 to 16

Certiﬁcate Application for Candidacy

•

Requirements after Admittance to Program

Required Supplemental Documents

Transcript for the highest level of education achieved (ofﬁcial transcript

translated into English)

•

One of the follow

ing minimum scores: TOEFL iBT 60; IELTS 6.0; CEFR B2

•

Ofﬁcial university transcript (ofﬁcial university transcript translated

into English) for two most recent terms of study; transcripts must

show excellent grades – majority of "A" and "B" (U.S.) grades.

Applicants who do not meet these requirements will be considered

on an individual basis for Conditional Admission.

• • • •

Proof of BA or expected completion date

•

One of the following minimum scores: TOEFL iBT 80; IELTS 6.5.*

NOTE: Students with TOEFL iBT scores below 20 or IELTS scores below 6 in

any individual skill area (reading, writing, listening, speaking) must

successfully complete (with grade ‘C’ or better) one academic English

course in each one of those skill areas; course(s) must be taken within the

ﬁrst quarter of studies at UCSB.

• • • •

ISP APPLICATION FOR ENROLLMENT: How to Apply

International Student Programs (ISP)

*TOEFL, iBT, IELTS test scores are valid for 2 years.

UNIVERSITY OF CALIFORNIA, SANTA BARBARA EXTENSION

INTERNATIONAL STUDENT PROGRAMS APPLICATION FOR ENROLLMENT

1 Personal Information

❏ Male ❏Female

Family/Last Name (as it appears in your passport)

First Name (as it appears in your passport)

Country of Birth Country of Citizenship

Date of Birth (month/day/year) e.g. JAN/01/1990 Age

Email Address (please print clearly)

Permanent address in home country Do not list a post ofﬁce box.

Address / Street / Apartment Number

Address (continued)

City / Postal Code / Country

Telephone (Country Code / City Code / Number)

Address where Acceptance Package with I-20 Form should be mailed

❏ different from permanent address ❏same as permanent address

Family / Last Name / First Name

Address / Street / Apartment Number

City / Postal Code / Country

Telephone / Country Code / City Code / Number (required)

Do not use post ofﬁce box. Information is sent via FedEx.

2 Program Information

STUDENT STATUS

❏ I am a new student

❏ I am a continuing ISP student

AREA OF STUDY (required)

My Area of Study—1st Choice or Major is: ________________________

STUDY OPTIONS

I am applying to the following study options:

To select multiple quarters of study in each Study Option mark all quarters desired.

Advanced English Program (AEP)

❏ Winter Year: ________

❏ Spring Year: ________

❏ Summer (ﬁrst 6 weeks) Year: ______

❏ Summer (entire summer) Year: ______

❏ Fall Year: _____

For dates, see: ISP Dates

University Immersion Program (UIP)

Academic Studies*

Professional Studies

Specialized Academic English Studies**

Technology Management Courses

❏ Winter Year: ________

❏ Spring Year: ________

❏ Summer (ﬁrst 6 weeks) Year: _______

❏ Summer (second 6 weeks) Year: ________

NOTE: For summer 6-week, academic courses must also be taken due to

limited number of professional studies courses

❏ Summer (entire summer) Year: _______

❏ Fall Year: _______

For dates, see: ISP Dates

* Academic studies courses end before the UIP end dates in winter and

spring. Students enrolled in UIP: Academic Studies are advised to plan on

staying for the entire length of the UIP dates. Students who are unable to

secure enough seats in academic studies courses, must take profession-

al studies courses to fulﬁll their F-1 visa requirements. Students must at-

tend all class sessions; missing sessions because of an early departure

date results in unexcused absences. See: ISP Dates

** Specialized Academic English Studies are not offered in summer

Graduate Studies Preparation Program (GSPP)

❏ Winter Year: ________

❏ Spring Year: ________

❏ Fall Year: ___________

For dates, see: ISP Dates

Teaching English to Speakers of Other Languages (TESOL)

❏ Summer For dates, see: ISP Dates

3 How to Apply for an F-1 Student Visa

International students studying full-time at UCSB Extension require an F-1

Student Visa.

NOTE: To comply with F-1 Visa requirements, students must pursue and

complete a full course of study: enroll in courses for credit, attend each

class, and follow the minimum course load for every quarter/term of their

studies. If students do not meet F-1 Visa requirements, their visa status

might be terminated. See: ISP F-1 Immigration Information/Full Time

Study Requirements.

STEPS TO OBTAIN AN F-1 VISA

1. The I-20 Form is (a certiﬁcate of eligibility for an F-1 Student Visa) will

be sent via FedEx to you by UCSB Extension upon acceptance into an

UCSB Extension program.

NOTE: The I-20 Form is sent to the address you listed in section 1 on this

Application for Enrollment Form.

2. Arrange for a F-1 Visa appointment with the U.S. Embassy or Consulate

in your home country as soon as you receive the I-20 Form.

NOTE: It may take several weeks to schedule the appointment.

3. Complete Form I-901 and pay the SEVIS fee to the Department of

Homeland Security, Immigration and Customs Enforcement:

http://www.fmjfee.com/i901fee/index.jsp

(PAGE 2 OF 5)

UNIVERSITY OF CALIFORNIA, SANTA BARBARA EXTENSION

INTERNATIONAL STUDENT PROGRAMS APPLICATION FOR ENROLLMENT

(PAGE 3 OF 5)

4. Print out your receipt (Form I-797) of your SEVIS fee payment.

5. Meet with the U.S. Embassy or Consulate representative in your home

country. Bring your:

n I-20 Form and

n Receipt (Form I-797) of your SEVIS fee payment.

For additional information on:

n F-1 Visas see: http://www.travel.state.gov/content/visas/english/

study-exchange/student.html

n U.S. Consulates around the world, see: http://usembassy.gov/

NOTE: The United States immigration laws change frequently. We encourage students to

contact the U.S. Embassy or Consulate in their home country for current information.

CURRENT I-20 STATUS

Do you need an I-20? ❏Yes ❏No

If YES, submit a readable copy of your passport page that shows your

name, date of birth, and photograph.

If NO, what will your Visa status be at the time you intend to study at UCSB?

FINANCIAL REQUIREMENTS

In order to obtain your I-20 form, you must submit proof that you have

the minimum ﬁnancial support to cover the costs of estimated tuition,

fees, and living expenses for each quarter (3 months) as listed at

ISP Fees and Deadlines.

PROOF OF FUNDING (identify the source of your funds)

❏ Personal/Own

❏ Family or Other Individual Name: _________________________

Relationship to Applicant: _____________________________

❏ Other (i.e. Government Sponsor) __________________________

All proof of funding must be in English. Acceptable evidence includes:

nA bank or ﬁnancial letter not older than 3 months attested to by a

bank or ﬁnancial institution.

nIf you are ﬁnancially sponsored by your government or another

agency, please send a copy of your award letter.

Your proof of funding is REQUIRED at the time of this application.

Your application will not be processed until we receive all required

documentation.

DEPENDENTS

List all dependents that plan to accompany you to UCSB Extension. Sub-

mit a readable copy of your spouse/dependent’s passport page(s) if they

are traveling with you on a F-2 Visa.

DEPENDENT #1

Family/Last Name First Name

Date of Birth (e.g., JAN/01/1997) Country of Birth

Relationship to You Email Address

DEPENDENT #2

Family/Last Name First Name

Date of Birth (e.g., JAN/01/1997) Country of Birth

Relationship to You Email Address

DEPENDENT #3

Family/Last Name First Name

Date of Birth (e.g., JAN/01/1997) Country of Birth

Relationship to You Email Address

4 Transfer Students

If you are a transfer student and currently in F-1 or J-1 status attending

another U.S. college or university, you must submit the following:

A. A copy of your current I-20 and the most recent I-20 you possess

that says “Initial Attendance” in box #1.

B. A copy of your F-1 Visa

C. Proof of F-1 status secured via

https://94.c6p.dhs.gov./I94/request.html

Are you currently attending another school in the USA?

❏ Yes (complete the section below) ❏No

Name of School You Are Currently Attending

Name of International Student Advisor

Advisor’s Telephone (Country Code/ City Code / Number)

Advisor’s Fax (Country Code/ City Code / Number)

Advisor’s Email Address

Final Date of Attendance

Will you be leaving and reentering the U.S. after completing your current

program and beginning your program at UCSB Extension?

❏ Yes ❏ No

If yes,

a) Date you will be departing the U.S. after your current study

program ends: ________________

(month/day/year)

b) Date you will re-enter the U.S. to begin your program at

UC Santa Barbara Extension: _________________

(month/day/year)

UNIVERSITY OF CALIFORNIA, SANTA BARBARA EXTENSION

INTERNATIONAL STUDENT PROGRAMS APPLICATION FOR ENROLLMENT

5 Payment

In order to reserve a space in the program, you must meet all admission

requirements and submit payment for the following fees:

n Application Fee (one-time, nonrefundable)

n Program Fee (due each quarter)

n Student Services Fee (due each quarter)

See: ISP Fees

NOTE: The following fees are payable after acceptance into the program and at

the time you enroll in individual courses:

n Course Fees

n Additional fees as appropriate

Application Fee (one-time, nonrefundable) $

Program Fee

Number of quarters (___) x ($____/quarter) = $

Student Services Fee

Number of quarters (___) x ($____/quarter) = $

Additional Fees

Late Application $

Late Payment $

Late Arrival $

TOTAL INCLUDED WITH THIS APPLICATION $

NOTE:

n Make sure your credit card/bank account has sufﬁcient funds available.

n Fees may be processed up to 3 weeks after receipt of the ISP Application.

n Notify your ﬁnancial institution that you have authorized money to be with-

drawn from your account by UCSB Extension (in the United States).

PAYMENT OPTIONS (U.S. dollars only. Do not mail cash.)

1. ❏ Credit Card ❍ Visa ❍ MasterCard

(Visa or Mastercard only)

Total to be charged: $ ____________________

Credit Card Number Expiration Date

Name of Cardholder Security Code

(Enter the 3 digit code that appears

on the back of your credit card)

Cardholder Address

City Postal Code Country

2. ❏ Pay by Money Order or Check in U.S. Dollars (exact amount only)

Total Amount Enclosed $ __________________________

Enclose payment payable to UC Regents. The money must be drawn on

an account held at a U.S. bank or a U.S. branch of your bank.

6 Emergency Contact

Family/Last Name First Name

Address / Street / Apartment Number

City / Postal Code / Country

Telephone (Country Code / City Code / Number)

Relationship to you: _________________________________________

7 Student Survey: How Did You Learn

about our program?

❏ A friend or family member

❏ A university/college counselor

❏ Social Media (Facebook etc.)

❏ Search engine (Google, Bing…)

❏ The UCSB Extension website

❏ A website specializing in education abroad programs

❏ News or other media

8 Student Signature

❏ I have read the information regarding ISP full time study require-

ments for F-1 Visa students. I understand that if I do not meet these

requirements, my visa status might be terminated.

❏ I understand that my application will not be processed until ALL

required documentation is received by UCSB Extension. I also under-

stand that a space in the program is not guaranteed and an I-20 Form

will not be sent until I have met all program admission requirements

and paid the following ISP fees: 1) Application Fee 2) Program Fee,

and 3) Student Services Fee.

❏ I have read the information regarding the cost of estimated ISP

tuition, fees, and living expenses for each quarter (3 months) of study

at UC Santa Barbara Extension. I certify that these funds are available

and I accept full responsibility for these expenses.

❏ I certify that the information contained on this application form is

true, correct and complete to the best of my knowledge. I understand

that any false or incomplete information may be grounds to deny my

application for entry into the program. By checking the box at the left,

I certify that I have read and agree with these statements.

Signature of Student/Applicant

Date

(PAGE 4 OF 5)

UNIVERSITY OF CALIFORNIA, SANTA BARBARA EXTENSION

INTERNATIONAL STUDENT PROGRAMS APPLICATION FOR ENROLLMENT

(PAGE 5 OF 5)

9 Supplemental Documents

You must submit ALL Supplemental Documents as required for the

program of your choice, see page 1 of this application.

NOTE: Additional supplemental documentation is required for transfer students

and dependents.

HOW AND WHERE TO SEND SUPPLEMENTAL DOCUMENTATION

Please remember to include your name on all documentation sent.

You can scan and email, FAX, or mail your documentation to:

Email Address: apply@extension.ucsb.edu

FAX: 805.893.4943

Mailing Address:

UCSB Extension

Student Services

University of California, Santa Barbara

Mail Code 1110

Santa Barbara, CA 93106-1110 USA

THANK YOU FOR YOUR APPLICATION!

UCSB Extension will mail your acceptance information as soon as

possible (usually within 2 to 3 weeks) after receipt of your completed

application with all required supplemental documents and fees.

Acceptance information is sent via FedEx.

Agent/Representative Information

Agency/Institution Name

Contact Name

E-mail Address