LP Checkout

Name: *

First

Middle

Last

Email: *

Confirm Email

Preferred Spoken Language: *

Student's Gender: *

Male
Female

Student's Date of Birth (mm/dd/yyyy): *

We accept students from age 17+

Student's Permanent Address (In home country): *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone: *

Student's Country of Birth: *

Student's City of Birth: *

Student's Country of Citizenship: *

Student Plans *

Student plans on attending a college or university.

Has the student already been accepted to a US Institution? *

Please write the name of the US Institution below: *

Does the student have any allergies? *

Please specify below: *

Does the student have any medical needs? *

Please specify below: *

Does the student have any special dietary restrictions? *

Please specify below: *

Visa Information

Do you have F1 visa? *

What kind of Visa do you have? *

Do you need a Form I-20 to apply for a student visa? *

Are you in possession of a valid US student visa and would like to transfer from another institution? *

If YES to the above, please fill out the name of the institution you are attending: *

Do you have dependent will travel with you on F-2 visa? *

Please list any dependents who will travel with you to the US and require an F-2 visa. You must enter dependent's name the same way it appears on the passport, and use a space for any special characters.

Dependent

Dependent Name: *

First

Middle

Last

Dependent Date of Birth (mm/dd/yyyy): *//

Dependent's Country of Birth: *

Dependent's City of Birth: *

Dependent's Country of Citizenship: *

Gender: *

Male
Female

Relationship to Student: *

Do you want to add more dependent? *

Dependent Name: *

First

Middle

Last

Dependent Date of Birth (mm/dd/yyyy): *//

Dependent's Country of Birth: *

Dependent's City of Birth: *

Dependent's Country of Citizenship: *

Gender: *

Male
Female

Relationship to Student: *

Emergency Contact

Contact Name: *

First

Middle

Last

Relationship: *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone (country and city code): *

Email *