Conversa Ingles Language Center

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For more information please contact us:

Conversa Language Center
817 Main Street, 6th Floor
Cincinnati, Ohio 45202, USA.
Phone: (513) 651-56-79
Fax: (513) 665-37-92
Email: conversa@iac.net

If you wish to apply to Conversa please complete the Application Form and submit it by fax or mail, or complete the form below. Thank you for your interest.

Title:
Name:		Family Name:
Address:		City:
E-mail:		Phone:
Fax:		Phone (mobil):
Postal Code:		Country:
Country of Birth:		Country of Citizenship:
Date of Birth: Month/ Day/ Year/		How many years have you studied English?
Do you have health insurance for the United States?:	Yes No	If the response is yes, please bring a copy with you to the United States.
When do you want to begin your classes?:		How many months do you want to study?

If you need an I-20 form to get a student visa, please mail or fax this application and proof that you can pay for classes and living expenses. Any one of the following is acceptable:

A current personal bank statement or letter from your bank indicating you have sufficient funds.
An Affidavit of Support from your parents or guardian and a bank statement indicating sufficient funds. Or if you are paying, a Financial Certification Form.
A letter from your employer or sponsoring agent guaranteeing sufficient financial support.
A scholarship letter from your sponsoring government or organization.

I understand my financial obligation to Conversa and accept responsibility for payment thereof. In case of illness and/or emergency, I give my permission to any appropriate medical center to examine and/or treat me and to make any necessary recommendations to outside physicians. Conversa will do everything possible to make its students' stay here safe and enjoyable. However, Conversa takes no responsibility for personal injury or loss or damage to personal property while at Conversa.

Signature of Applicant:		Date:
Signature of Applicant's Guardian: (If applicant is under 21)		Date: