Study English at Pacific International Academy

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Application

Please make sure to complete all fields. Incomplete applications may delay the processing of your file. A $50 non-refundable application fee is required in order to process your application. You can contact us via e-mail for various payment options.

Contact Information

Family Name:
First Name:
Middle Name:
Gender:
Address in home country:

City:
State / Province:
Country:
Postal Code:
Home Telephone:
Fax:
E-mail:

Registration Information

When would you like to begin your studies?	of

Have you ever applied to PIA/Marylhurst?	No Yes When?

Are you interested in attending Marylhurst University after completing the ESL program?	No Yes

Personal Information

Date of Birth:	19

Country of citizenship:

Country of birth:

Are you currently in the United States?	No Yes: Type of visa:

If so, address in the United States:

City:
State / Province:
Postal Code:

Education Information

The most recent school you have attended:

City / State / Country:

Graduation date:	of

Highest degree completed:

Additional comments or questions:

By submitting this application I agree to the following:

1. I have read and understand the admissions and enrollment procedures for PIA.

2. I have read and understand about tuition and fees relating to my admission and enrollment at PIA. I have read and understand the PIA refund policy.

3. I understand that tuition will only be collected after admission and enrollment.

4. The information entered on this application is correct and complete.

I understand and will comply with the statements above.

17600 Pacific Highway 43, Marylhurst, Oregon 97036-0267
Telephone: 503-699-6310 Fax: 503-697-7188 E-mail: info@piaschools.edu