Application Form

Complete all fields of this application.

Applicant personal information

• First name
  
• Middle name
  
• Last name
  
• Suffix
  First 
  Second 
  Third 
  Fourth 
  Junior 
  Senior 
  

Note: Name must match your passport.

• Permanent Home Address
  
• City
  
• State/Province
  
• Country
  
• Zip Code
  
• Home Telephone
  
• Other Telephone
  
• Email Address
  
• Fax
  
• Date Of Birth(day/month/year)
  
• Gender:
  Male 
  Female 
  
• City of Birth
  
• Country of Birth
  
• Nationality
  
• Education:
  Elementary School 
  High School 
  College/University 
  Other 
  
  
  
• Address of the applicant in Miami (if known):
  
• Desired length of study (months):
  
• Desired program start date (month/year):
  
• Send file
  
  

In case of emergency during your stay in Miami, who should we contact?

• Name
  
• Relationship
  
• Telephone
  
• Cell phone
  
• Fax/Email
  

Payment of Application and courier fees ( non-refundable )

Please select payments you will make to CCLS:

• A)

  Application Fee (U$100.00) 
  Application Fee for Change of Status (U$300.00) 
  

• B)

  Courier Fee: Americas, Austria, Belgium, France, Germany, Italy, Netherlands, Portugal, Spain, Scandinavia, Switzerland, UK (US$ 75) 
  Courier Fee: all other countries (US$125) 
  Student or his appointee will pick up the I-20 at CCLS 
  

• C)

  SEVIS Fee (U$200.00) 
  Courier Fee: all other countries (US$85) 
  Student will make the SEVIS payment himself (Please refer to Conditions of Admissions) 
  

Please select one form of payment:

• A)

  Through local agent 
  

• B) Credit/Debit Card:

  Visa 
  Master Card 
  American Express 
  

• Credit/Debit Card Number:
  
• Expiration Date(month/year):
  
• Security Code (4 digits AMEX and 3 digits Visa / MC):
  
• Credit Card Billing address:
  
• Name on Credit Card:
  

• C)

  Wire Transfer 
  

Send paymento to:

CCLS

Bank of America

ABA 0260-0959-3

Swift key BOFAUS3N

Account no. 001595461335

• D)

  Check (drawn on a US bank) 
  Money Order 
  Traveler's Checks 
  

All checks and money orders must be made to CCLS and mailed/delivered

CCLS

3191 Coral Way, suite 114

Miami, FL 33145

Travel Insurance Information

Upon approval of their F-1 visa petition, students must purchase their own travel insurance before leaving their country of origin. Proof of insurance must be submitted to CCLS unless you are staying with relatives or an adult in Miami who will be responsible for your medical needs. Please contact CCLS if you need help in obtaining travel insurance.

Agreement

• 
   I understand and accept the terms contained in the Conditions of Admission and this Application for Admission.

Note: If applicant is under the age of 18, the legal guardian must sign this application and send it to CCLS by email or fax. Please click here to download the application.

• Name of Legal Guardian
  
• Relationship
  

Your application will only be processed when CCLS receives all required documentation and application fee payment. CCLS requires that the student pay the first month of classes no later than five days after receiving his F-1 visa petition approval.