Name:
Age:
Telephone:
E-mail:
Years of school completed:
What college degrees do you have?
Current school:
Current major:

Have you taken the GMAT?   (CIRCLE ONE): Yes  No
Date taken:
Score:

Have you taken the TOEFL?   (CIRCLE ONE) Yes  No
Date taken:
Score:

How many years work experience do you have?
Type of work:
Position/Title:

Do you have a preferred location in the U.S.? For example, east coast, west coast, California, New York, etc.   (CIRCLE ONE) Yes No
If Yes, what location?

Do you have a preferred school in the U.S.?   (CIRCLE ONE)  Yes No
If Yes, what school?

What type of degree do you want?

What subject or field do you want to major in?

Do you want to attend a special English program in the U.S. before you go to a school there?   (CIRCLE ONE) Yes No

How did you hear about AEGC?