Office Use Only

Student ID# __________________

Contact date: _______________

ZONI LANGUAGE CENTERS Received by: _________________

STUDENT APPLICATION FORM Comments:

Attn: MARY PACHECO-DEJESUS _______________________________

_______________________________
Please fill out the application below. If you need assistance, please contact one of our student
representatives at: Queens Campus (718) 5659400. After completing the form either save it and Application Status:
email it as an attachment to Mary Pacheco-Dejesus or print it and mail it.
Qualified Denied

Non-Qualified Approved

PART I - Biographical Data

Student Information:

Suffix:
(Mr. Ms. Jr., Etc.)

Name:
Last Middle First

Gender: Male Female Date of Birth ____/____/____

MM / DD / YYYY

Foreign Address: U.S. Address:

Street Line: Apt # Street Line: Apt #

Street Line: Street Line:
City, State, Zip: City, State, Zip:
Country: Country:

Foreign Tel. No.: Home Telephone Number:

Email address: Cell Phone Number:

Foreign Place of Business:
Residency:
Country of birth: Country of Citizenship: Country of Residency:

Sponsor Information

Last Name: __________________ First Name: __________________ MI: ____

Number and Street: ________________________________________________

City: _____________________ State: ________ Zip Code: ________
Telephone: ________________ Fax: ______________ Email: __________________

Relationship to the student: ___________________________________________________________-

The following information is required in order to provide statistical data in compliance with federal and state non-discrimination requirements. Response is voluntary
and the information will be kept confidential. Refusal to provide this information will not subject the applicant to any adverse treatment.

Check the one race or ethnic group that best applies to you (optional):
American Indian or Alaska Native White Other
Hispanic Black Do not wish to respond
Asian or Pacific Islander

PART II - Admissions Data

Choose a Campus: Application Status: Intended Workload:

Queens Intensive Full-Time
Manhattan Semi Intensive Part-Time
New Jersey Super Intensive
Transfer
Regular

Specifications for preparing and issuing your I-20 Form:

Initial Attendance Change of Status
Please indicate the purpose of I-20 form. Transfer Reinstatement
Other
Please indicate the date on which you will start your classes ___________
Note: The starting date must be on a Monday

Do you want us to help you find accommodations? Yes No

Would you like to be considered for the Zoni 1-year (48 weeks) certificate program? Yes No
To obtain the Zoni 1-year (48 weeks) certificate, you must enroll in a full-time study program for 48 weeks and maintain a high attendance rate. The Zoni certificate
will not only certify your improved English skills; it will help open doors for you around the world.

Have you previously applied to Zoni? Yes No

Have you ever taken a Zoni course? Yes No
Please indicate the number of years you have studied English.

How long are you going to study at Zoni? _________

PART III – Visa Requirements Data

Passport Number: You must have a passport valid for at least 6 months.
Students who are neither U.S. citizens nor permanent
residents of the U.S. must complete the section below.
Are you currently residing in the U.S.? Yes No
If yes, which visa do you hold? M-1 J-1 B-1/B-2 F-1 Other :

Date of entry into the U.S. / / Visa Expiration Date: / / Passport Expiration Date: / /
mm/dd/yyyy mm/dd/yyyy
If you currently have F-1 Visa status, Name the institution that issued your I-20AB:

INS admission number (Refer to your I-94 card)

Current non-immigrant status (Refer to your I-94 card)

SEVIS Number __________________________________

Mail Service Request
Yes Yes, I would like my I-20 form to be sent to my home address.I understand that a mailing fee must be paid before my documents can be sent.
No No, please hold my I-20 form, which will be claimed by my relative, representative or by me.

Are you including your children and spouse as dependents (F-2 status holders)? Yes No
If Yes, please complete the Part IV- Dependents information sheet otherwise skip to Part V- Educational Data

PART IV – Dependents Information Sheet:

Dependent I
Last Name: First Name: MI:
Date of Birth: Sex: Female Male Nationality: Country of Birth:
INS admission number (Refer to your I-94 card):
Current non-immigrant status (Refer to your I-94 card):
Passport Expiration Date:
Relationship to the Student:

Dependent 2
Last Name: First Name: MI:
Date of Birth: Sex: Female Male Nationality: Country of Birth:
INS admission number (Refer to your I-94 card):

Current non-immigrant status (Refer to your I-94 card):

Passport Expiration Date:
Relationship to the Student:

Dependent 3
Last Name: First Name: MI:
Date of Birth: Sex: Female Male Nationality: Country of Birth:
INS admission number (Refer to your I-94 card):
Current non-immigrant status (Refer to your I-94 card):
Passport Expiration Date:
Relationship to the Student:

Dependent 4
Last Name: First Name: MI:
Date of Birth: Sex: Female Male Nationality: Country of Birth:
INS admission number (Refer to your I-94 card):
:
Current non-immigrant status (Refer to your I-94 card):
Passport Expiration Date:
Relationship to the Student:
PART V – Educational Data:

Highest level of education completed:

Primary School High School Undergraduate School Graduate School Associate Degree

Please indicate the tests you have taken GRE GMAT TOEFL

Business Experience/ Extra Curricular Activities (optional)

List any business/work experience that supplements your academic background:

Firm and Location:

Nature of Work:
Dates From: To:

List any business, professional and social organizations in which you have been active and any professional licenses that you hold:

List any awards, honors, sports activities, clubs and organizations, you participate(d) in

Parental Information

Mother’s Name: __________________________________ Father’s Name: __________________________________

Address: _________________________________________ Address: _________________________________________
City, State and zip: ________________________________ City, State and zip: ________________________________
Phone: ___________________________________________ Phone: ___________________________________________
Occupation: _______________________________________ Occupation: _______________________________________

Do you have any relatives who have attended Zoni? Yes No

If you have any siblings, please write their names: _________________________________________________________________

PART VI – Essay

Please prepare an essay using any word processing application (Microsoft Word, Word Perfect,etc.) and attach it this application
form while submitting. In writing your essay, please make sure the followings.

 Double-space your document

 Spell-check your document and proofread it carefully.

Essay Topic: What are your career goals, and how will your education at Zoni Language Centers support these goals?

Note: Submitting this application does not guarantee your admission to Zoni. All required documentation must be submitted along
with this form.

CONDITIONS OF APPLICATION & SIGNATURE

I certify that the information supplied on this application is complete and correct to the best of my knowledge. I agree to abide by the
rules and regulations of the school as set forth in the catalog of Zoni Language Centers’ catalog, with which I am familiar.

SIGNATURE OF APPLICANT: ____________________________________________ DATE: ___________________________

Zoni Language Centers/ 78-14 Roosevelt Ave., Jackson Heights, NY 11372