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American College Institute & Circuit -

Applicant Data

Last (Family) Name:*
First (Personal) Name:*

Name as it will appear on passport (if different than above)

Last (Family) Name:
First (Personal) Name:

Name on School Records (if different than above)

Last (Family) Name:
First (Personal) Name:

Birth Date: -- 01 02 03 04 05 06 07 08 09 10 11 12-- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31---- 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Email Address:*
Home Telephone:*
Mobile Telephone:*
Complete Permanent Address:*
If your mailing address is a boarding school, include name of school below:
Passport Number:*
Citizenship:*
Ethnic Origin:*
Birthplace (City):*
Birthplace (Country):*
Possible Areas of Academic Instruction:*
Languages of Fluency:*
Language(s) Spoken at Home:*
Have you ever been subject to a serious disciplinary action or ever been suspended or dismissed?YesNo
If Yes, please give a detailed description of previous disciplinary actions:

Family Data

Father or Guardian Last (Family) Name:*
First (Personal) Name:*
Occupation/Title:*
Organization:
Can your father or guardian be reached at your permanent address?YesNo
Mother or Guardian Last (Family) Name:*
First (Personal) Name:*
Occupation/Title:*
Organization:
Can your mother or guardian be reached at your permanent address?YesNo
Did your Father attend an American College/University?YesNo

Please include College Name & Year's Attended.

If Yes, please tell us which American College/Universities:
Did your Mother attend an American College/University?YesNo

Please include College Name & Year's Attended.

If Yes, please tell us which American College/Universities:
Father's College/University (if he did not attend College in America):
Year's Attended:
Mother's College/University (if she did not attend College in America):
Year's Attended:

Educational Data

Secondary School you now attend (or from which you will graduate):*
Complete School Address:*

Date of Entry: -- 01 02 03 04 05 06 07 08 09 10 11 12-- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31---- 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Date of Graduation: -- 01 02 03 04 05 06 07 08 09 10 11 12-- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31---- 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Counselor or Primary Instructor:*
Title:
Telephone:*
Facsimile:*
Email:*
Have you attended any college/university courses for credit?YesNo
Name of College/University:
Location (City/State/Province/Zip/Postal Code/Country):
Would You Like to List Another College?YesNo
Name of College/University:
Location (City/State/Province/Zip/Postal Code/Country):
Would You Like to List Another College?YesNo
Name of College/University:
Location (City/State/Province/Zip/Postal Code/Country):
Check Any That Apply:Not Currently Attending SchoolGraduated from Secondary School Early
If there has been any interruption in your education for any reason, please describe in detail below:
Have you taken test of English as a second language (TOEFL or other exam)?YesNo

Please list any Private or After School Academies

If Yes, Institution Name:

From: -- 01 02 03 04 05 06 07 08 09 10 11 12-- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31---- 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

To: -- 01 02 03 04 05 06 07 08 09 10 11 12-- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31---- 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Achievement or Program Certificates: Please forward a copy of all certificates.

Certificate or Achievement Type
Institution:

Date of Certification: -- 01 02 03 04 05 06 07 08 09 10 11 12-- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31---- 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Extracurricular, Personal, and Volunteer Activities

List your principle extracurricular activities in the order that interests you. Include specific interests and major accomplishments.

Activity:
Grade Level:9 10 11 12 PS
Approximate Time Spent Each WeekLess Than 5 5 - 10 10 -15 15 - 20 More Than 20
Number of Weeks/Year:1-5 5-10 10-15 15-20 20-25 25-30 30-35 35-40 40-45 45-52
Positions Held, Honors Won:

Academic Honors - Briefly list any scholastic honors or distinctions you have won since ninth grade:

Work Experience - Please list any principal jobs held in the past two years:

Employer:
Nature of Work:

From: -- 01 02 03 04 05 06 07 08 09 10 11 12-- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31---- 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

To: -- 01 02 03 04 05 06 07 08 09 10 11 12-- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31---- 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Hours Worked Each Week:

Personal Essay

We are looking for an essay that will help us know you better as a person and as a student. Please write an essay in English (300-500 words) on one of the topics below. You can upload your essay below -- but please also be sure to print out and send a hard copy with your application.

Which of the following topics did you write your essay on?Discuss some issue of international concern and its importance to you. Evaluate a significant experience or dilemma you have faced and its impact on you. Identify a person who has had a significant influence on you. Describe the influence.
Please Attach Your Essay Here:

Travel Agent Information

Please give us the name and contact information of your travel agent below:

Travel Agent Name:*
Travel Agent Address:*
Travel Agent Email:

Please enter the characters you see in this picture:

Characters:

This helps prevent automated form submissions. If you are not sure what the characters are, make your best guess. You will have another try in the next screen. Can't see the image? Click here for an audible version in english.

Important Applicant Information

Online Submission

1. Submit application online
2. Upload personal essay
3. Print and have completed 2 Instructor Evaluations
4. Send by facsimile the following:
• Completed and signed Personal Essay Cover Sheet
• 2 completed and signed Instructor Evaluations
• Copy of Top 10 Certificates

Facsimile Submission

1. Complete and print the PDF application
2. Print and have completed 2 Instructor Evaluations
3. Send by facsimile the following:
• Completed application
• Completed and signed Personal Essay Cover Sheet
• 2 completed and signed Instructor Evaluations
• Copy of Top 10 Certificates
  
  

Our preference is that the initial application is submitted online, along with an upload of the personal essay. Additionally, the applicant may choose to print the PDF version of the application and submit all materials manually. An application cover sheet must be submitted with any required materials.

If you submit the application online, you should receive a confirmation via email, to the email address provided within 48 hours. Please leave a valid email address.

Applicants will be notified within 72 hours after receiving all documentation of the Board of Admissions decision regarding acceptance into the ACIC program.

Contact Information

Contact information:

Fax application matierals to 1-512-392-3093

If you have any questions about the application or how to apply, please send an e-mail to info@collegetoursofamerica.com.

1. Home
2. What is ACIC?
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5. Apply Online
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