| Last Name: | |
| First Name: | |
| Middle Name: | |
| Gender: | |
| Date of birth: | |
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| Country of Birth: | |
| City of Birth: | |
| Country of Citizenship: | |
| Native Language: | |
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| Are you currently in the USA? | |
| If yes, which visa do you hold? | |
| Where did you find out about Bell Language School? | |
| What is the level of your english? | |
| When do you want to start your classes? | |
The above information is correct, and I am aware that the issuance of the I-20 form by Bell Language School,
admission to the school's programs and continued attendance in the school are subject to payment of all fees and tuition.