TERRA NOVA ENGLISH LANGUAGE CENTER APPLICATION for ADMISSION

Steps for Enrollment in the TOEFL Preparation Course at Terra Nova: Please read the instructions before filling out this application for admission. Complete the application form and carefully review it for accuracy. Your personal information will be used exclusively for institutional research and will not be disclosed to any third party under any circumstances without your permission. Your cooperation in completing this application form is highly appreciated. Write a personal statement and an essay. Submit the application for admission, along with the personal statement and the essay as well as any other supporting materials, by electronic mail directly to Terra Nova at terranovamd@yahoo.com. There is no application fee for the TOEFL Preparation course. After all of your application documents have been received and carefully considered by Terra Novas TOEFL instructor, you will be invited for an English proficiency evaluation test consisting of a short written grammar and vocabulary exercise and an oral interview. Once you have been accepted, you will be placed in one of the sections (groups). Your placement will depend on your preference stated in the application for admission, the availability of seats, and several other criteria. Soon afterward, an acceptance letter with your enrollment information will be sent to you be electronic mail. You must confirm your enrollment and agree with the placement before your classes begin. Your tuition fees must be paid in full during the first two weeks of the semester. The enrollment in our TOEFL Preparation course is highly competitive and you may wish to apply well in advance. All our qualified applicants are enrolled on a FCFS (first-come, firstserved) basis, taking into consideration their English language proficiency level, which is determined by the English proficiency evaluation test, as well as such important admission criteria as academic and personal achievements and plans, extracurricular activities, duties and responsibilities, interpersonal skills, and travel experiences, among others. No single factor, attribute, or characteristic is used to determine admission.

IMPORTANT:

All application documents will be retained for one year from the semester for which you applied. Afterward, they will be discarded if the applicant has not enrolled in the course or deferred the application to a later semester. Should you have any questions regarding the enrollment process, please do not hesitate to contact Terra Nova or visit us online at www.terranovamd.com. Terra Nova 508 (left wing), 7 Miron Costin Street, Rcani Sector, Chiinu MD-2068, Moldova Phones: (373 22) 499 530 (373 22) 878 045 (373 79) 581 561 Skype: terranovamd Yahoo! Messenger: terranovamd

You are welcome to join our TOEFL in Moldova Facebook group!

General Information
Full Legal Name:
First / Given Last / Family
MALE FEMALE

Middle / Patronymic
SINGLE MARRIED

Preferred Name: Date of Birth:

mm / dd / yyyy
YES NO

Sex: Place of Birth:

City District / Region

Marital Status:

Country

Are you a citizen of Moldova? Home Address:

House

If you are not, what citizenship do you hold?

Country

Street

Apartment

City

District / Region

Country

ZIP Code

Landline Phone: E-mail Address:

YES NO

Cellular Phone: Skype Name:

YES NO

Do you use e-mail on a regular basis? How did you find out about Terra Nova and its TOEFL Preparation course?

Do you use Skype on a regular basis?

Placement
Academic Year: 2012/2013 2013/2014 Entry Semester: Spring Fall

Sections:

9:30 - 11:30 a.m. M. W. F. 9:00 a.m. - 12:15 p.m. Tu. Th.

4:30 - 6:30 p.m. M. W. F. 3:00 - 6:15 p.m. Tu. Th.

7:00 - 9:00 p.m. M. W. F. 6:30 - 9:45 p.m. Tu. Th.

9:00 a.m. - 12:15 p.m. Sat. Sun.

Preferred Section Number(s):

Personal Statement
Please write a statement of your general academic plans and attach it to your application before submission. Describe (500 words maximum) your main academic and personal interests, why you wish to prepare for the TOEFL with Terra Nova, and your plans for the future after you receive your TOEFL scores. Please include experiences in school or work that have helped to prepare you for this course of study. This statement should be personal and written by the applicant.

Education
School: Address: From: College: Address: From: To: Degree: To: Grade /evel: Major: Phone: GPA: Profile: Phone: GPA:

Extracurricular Activities

Employment
Company: Address: From: Duties: To: Job Title: Field: Phone:

Languages
Native /anguage: Other /anguages:

English 6tudy

Where 6tudied:
Date 7aken: Reading: Listening: Reading: Listening: Speaking: Writing: Speaking: Writing:

If you have taken the TOEFL, please provide the date and your scores:

If you havent taken the TOEFL , please rate your English skills on a scale from 5 (fair) to 10 (excellent):

Travel Experience
Countries 9isited:
YES NO

Have you ever been to the United States? If yes, please provide details of your visit(s):

Essay
Please write an essay (500 words maximum) on a topic of your choice or on one of the options listed below, and attach it to your application before submission. Please indicate your topic by checking the appropriate box.

Evaluate a significant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you. Discuss an issue of personal, local, national, or international concern and its importance to you. Indicate a person who has had a significant influence on you, and describe that influence. Describe a fictional character, a historical figure, or a creative work (as in art, music, science, etc.) that has had an influence on you, and explain that influence. Topic of your choice.

Additional Information
If there is any other information that you would like to provide regarding special circumstances, additional qualifications, etc., please do so on a separate sheet.

Disclaimer and Signature

By my signature, I certify that, to the best of my knowledge, the information provided in my application is accurate and complete. I authorize review of my application for the TOEFL Preparation course offered by Terra Nova. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation or expulsion, should the information that I have certified be false. Signature: Date:
mm / dd / yyyy

Terra Nova is committed to fulfilling its mission without discrimination on the basis of race, color, national or ethnic origin, language, religion, age, sex, gender identity, ancestry, marital status, sexual orientation, disability, or veteran status.