Required Documents for Application, F-1 Visa Students

Name *

First

Last

Email *

Confirm Email

Phone *

Date of Birth *

Which School Location? *

POLY Languages at Irvine
POLY Languages at Los Angeles

What is your status? *

Initial (I want to go to the US. I need an F-1 visa.)
Initial COS (I am in the US. I want to change my visa to F-1.)
Transfer (I have an F-1 visa. I want to transfer.)

Medical Insurance

All F-1 students and their dependents are required to purchase medical insurance prior to the start of their studies at POLY. The students may choose their own insurance plan or the International Student Protection (ISP) plan by the insurance company, J. Deutsch Associates, Inc. The plan is for international students and scholars in the US.

Medical Insurance *

I need assistance in applying for medical insurance with ISP.
I have or plan to have medical insurance with another provider.

Required Documents

The required documents are based on your selection, “What is your status?”.

Emergency Contact

In case of emergency, state the person that you wish us to contact.

Name *

Relationship *

Email *

Phone *

Acknowledgement and Agreement

Identity Verification Fee *

$1.00 (non-refundable)

The credit card information you provide will be used to identify the person completing this form. The cardholder’s name must match the name of the student or the sponsor. The sponsor refers to the person whose name appears on the financial statements submitted with this form. For exceptions, please email us after you complete this form.

Total due *

$0.00

Once you’re accepted, we will assist you with all aspects of the admission process.

Stripe Credit Card *

Card

Name on Card

Assisted by (Optional)

State the name of the advisor who assisted in completing this form.

Acknowledgement *

By checking this box, I confirm that I have read and agree to the terms and conditions stated herein. I acknowledge that applying for a student visa, changing my status, or seeking reinstatement is solely my responsibility, and the school makes no guarantees nor assumes any liabilities in these matters. Furthermore, I acknowledge receipt of the school’s digital catalog, available online, and agree to abide by the refund policies and procedures as stated within it.

Required Docs for Application

Required Documents for Application (F-1 Student Only)

Medical Insurance

Required Documents

Emergency Contact

Acknowledgement and Agreement