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Personal Information
Student Status



*Do you need Form I-20 (F-1 Students)?
U.S. Address (If you are in the U.S. or know where in the U.S. you will reside)
Foreign Address (The place you reside when you are not in the U.S.)
Mailing Address (The address to which you wish your acceptance package to be delivered.)
Location/ Program Information
*Which Center?:

Which Term Will You Start (Select ONE)?
Which program ?
How Many 4-Week Terms (2-12)?:
Term Fee  :
$
Discount   :
$


Total          :
$
Airport Transfer Service($80)

* Would you like POLY to arrange airport pick-up upon your arrival?
Accommodation Arrangement Service($200)

*Would you like POLY to arrange your housing?
If yes, complete below.
From:
To:

* Type of Housing Preferred

Do you smoke (smoking is allowed only in the designated areas)?

Do you have any health problems, allergies, or concerns you would like us to know?
Emergency Contact

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

Payment
Select applicable fees due with this application.
$150.00
$100.00
*Acceptance Packet (Must select one)




$65.00

$30.00

$0.00
Total Fee Due with this Application:
*Select Payment Method


*
*
*
*
*
Acknowledgement

*    I certify that I have received the School Catalog, and I have read, understood, and I agree to all the terms and conditions of this Application for Admission form and the School Catalog. Furthermore, I agree to accept full responsibility for all my expenses while attending POLY and for my actions while participating in excursions or any other activities. I agree to assume all risks of harm arising from such participations. In case of illness or injury, permission is granted to an appropriate medical center to undergo examination or treatment. I further authorize POLY to release my records to my agency, guardian, sponsor, and to any colleges or universities to which I apply.


05/25/2017