ELPP Application - Southern Connecticut State University

ELPP application. Please fill out the form below.

First Name Middle Name Last Name

Date of Birth

Month Day Year

Permanent Mailing Address City Province Country Postal Code
Mailing Address in USA (if different) City State Postal Code
Phone Number (please include country code) Phone in USA (if different) E-Mail Address Confirm E-Mail Address Have you completed High School?

Yes No

What is your current immigration status? Will you require an I-20 from the ELPP program at SCSU?

Yes No

Country of Citizenship Birth Country Will your spouse or any other dependent(s) accompany you?

Yes No

Are you in the USA now?

Yes No

Are you a student in the USA now?

Yes No

If so, what school are you attending? What is your housing preference? What is your English ability? What is your TOEFL Score? How many semesters do you plan to attend in ELPP? What do you plan to do after ELPP completion? What would you like to study? How did you hear about the ELPP program at SCSU?

By submitting this application, I certify that my responses are true and correct. I understand the $50 application fee is non-refundable and not subject to a refund after submitting it.

By selecting this box, I agree that Southern Connecticut State University, to the extent it may be covered by FERPA, may release my student record as necessary to facilitate admissions, enrollment, and continued progress at the University. This authorization specifically permits the sharing of information between Southern Connecticut State University and any other entity directly responsible for my recruitment or continued participation in any program at the University.

I have read and agree to the Student Enrollment Agreement.

Entering your name in the box below serves as your legal signature Enter today's date below

When you click "submit" below, you will be taken to our secure payment portal to pay the application fee.