Online Application Form
   

※こちらは、英文になっております。ご不明な点は申請要綱を参照して下さい。
This form is to send application to Cal America Education Institute only. Please read instructions before you fill out application form. You can, however, click on icon next to the item at any time if you want to view instructions again.

You must provide correct information on every item in red under Part 1 to 7 and Part 9 when complete this application form. Make sure you include an active e-mail address because we'll send confirmation to the e-mail address you provided. After you complete the form, click on "Submit" button once to send your application to Cal America.

※すべて、英語（ローマ字）で埋めてください。

  
Part 1: Student Information
Last/Family Name名字:
First Name名前:
Gende性r:
     Male    Female
Date of Birth生年月日:
 ,
Country of Birth出生国:
City of Birth出生市:
Country of Citizenship国籍:

Part 2: Mailing Address
Address現住所/番地・町:
City市・郡:
State/Province都道府県:
Zip/Postal Code郵便番号:
Country国:
Phone電話番号:
Fax:

Part 3: E-mail Address
You must provide an active e-mail address to complete this form. We send confirmation to this e-mail address.
E-mail:
  

Part 4: Contact Person
In case of emergency, Cal America can contact the following person
Name名前:
Phone電話番号:
E-mail:

Part 5: Visa and I-20
If you plan to enter the U.S. on a student (F-1) visa, please answer "YES" below. If your answer is "NO", Cal America will not issue I-20 for you.
Cal AmericaからI-20(入学許可証）
を必要としますか？?
 YES* NO*
* If you request I-20 your initial fee will be $350 which includes application fee of $100, tuition deposit of $200, and express mail service of $50. On the other hand, if you do not request I-20 from us, your initial fee will be only $300 (less express mail service fee of $50).
Important: If you're planning to apply student (F-1) visa, you are required to pay a fee called SEVIS I-901 fee to the US immigration before your scheduled visa interview. You can pay the fee by yourself or you can ask Cal America to pay the fee on your behalf. Please add $100 to your total if you want Cal America to pay the fee for you.
Answer the following questions if you are now in the United States.
What type of visa do you hold?ビザのタイプは？（例：学生ビザF、訪問ビザB）
Do you plan to change your status in the U.S.?
アメリカでビザの種類を変更する予定ですか？
 [ Type "YES" or "NO" ]
If you have dependent(s) who need dependent visa and will enter the U.S. with you, provide information below*:
あなたと同じビザを取得し、一緒にアメリカに入国予定の方はいますか？
Name (Last name, First name)
Date of Birth
Country of Citizenship
Relationship

* You do not need to provide information if your dependent(s) will not stay with you while you study in the U.S.

Part 6: Course Information
Choose a course and date you want to study at Cal America. Date will appear as starting date on the I-20 if you request.
What course do you plan to attend?
ご希望のコースは？
When do you plan to begin your class?
入学予定日は？
 *

* The date you choose here will show as your program start date on your I-20.
Tips: Choosing a date that is at least 6 weeks from now will give you enough time to send other required documents to us and to prepare for visa application. This will also give Cal America enough time to process your application and send form I-20 and acceptance documents to you on time.

Part 7: Source of Financial Support
Choose a type of financial support残高証明者: Self support Family fund Other sponsor
Name of sponsor that will appear on the financial support document:
スポンサーの方は、その人のお名前
Relationship with student:
あなたとの関係
You must send a separate financial support document to Cal America along with your payment.


Part 8: Additional Services
Please let us know now if you want to request additional service(s).
Housing Service
Do you want us to arrange your housing?
ハウジングサービスを希望しますか？
 YES ($250 fee is required) NO
If "YES", what type of housing do you prefer?
タイプは？
Below, please provide additional information to help us arrange your housing to suit your preferences.
Would you accept a family with small children?
ステイ先に小さな子供がいても構いませんか?
Would you accept a family with pets?
ペットは大丈夫ですか？
Do you drink alcoholic beverages?
アルコールを飲みますか？
Do you smoke?
タバコを吸いますか?
Airport Pick-up Service
Do you want us to arrange airport pick-up?
空港送迎サービスを希望しますか？
 YES ($75 fee is required) NO
空港送迎サービスをご希望の方は、詳しいフライト情報をメールしてください (admission@cal-america.com) 。
When do you plan to arrive?到着予定日
Which airline?エアライン
What is the flight number?フライトナンバー
Arrival time?到着時間

Part 9: Payment

お支払方法:
  Bank Draft（海外小切手） Cashier's Check（送金小切手）
Money Order （国際マネーオーダー） Wire Transfer(銀行口座振込） ($40の手数料をいただきます)
 クレジットカード (5%の手数料をいただきます). authorization formをダウンロードし、国際郵便かFAXにて送信してください。
When do you plan to send payment?
お支払い予定日は？
 [日付：月/日/年]

以下の費用をお支払いください。:

Non refundable application fee　入学金 (required)

US $

Tuition Deposit　学費前金 (required) US $

Express mailing fee 国際メール費用(required)

US $

Housing Placement Service: $250.00

 US $
Airport (LAX only) Pick-up Service
空港送迎サービス:$75.00		 US $
Wire Transfer Fee（銀行口座振込み手数料）: $40.00 US $
合計金額を計算するために以下のボタンをクリックしてください。
US $ *

*ISEVIS I-901を学校にてお支払い希望の方は、以上の合計金額に$100を足してください。
*クレジットカードでお支払いの方は、以上の合計金額からさらに5%の手数料を足してください。
*また、クレジットカードでお支払いの方は、SEVIS I-901費（$100）を足した後に、5%の手数料を計算してください。

Please fax or e-mail confirmation to us after you send payment.

 

 

 

 

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