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CELAC Online Course Application
The Center for English & American Culture (CELAC) at the University of New Mexico is offering
online courses the will run for eight weeks. Deadline to Apply: May 15th at 5PM (MST)
I would like to enroll in the following course(s):
Academic Writing
Academic Reading
TOEFL iBT
Instructions:
1. Complete application
2. Pay $200 course registration fee online at: https://secure.touchnet.com/C21597_ustores/web/product_
detail.jsp?PRODUCTID=817&SINGLESTORE=true
3. Scan and email: completed application, registration fee receipt, and copy of current photo ID or
passport page to CELAC at: [email protected]
4. You will receive an email with instructions regarding course access.
Please print or type clearly
Full Name: _______________________________________________________________________________________
Family Name
Given Names
Gender:
Male
Female
Date of Birth: Month ______ Day ______ Year ________
Permanent address in home country: ______________________________________________________________
Street Address
__________________________________________________________________________________________________
City
State/Province
Postal Code
Country
Home Telephone: ______________________ Student Email: _________________________________
Social Security Number (if applicable): _____ - _____ - ________
My knowledge of English is:
Intermediate
High-Intermediate
Advanced
(Must have a minimum intermediate to advanced knowledge and understanding of English)
Family or Friend
E-mail
Social Media
CELAC webpage
Newspaper Ad
Agent: ____________________________
__________________________________________________________________________________________________
Please indicate how you heard about this course:
I was or am a CELAC or UNM Student. UNM ID Number: __________________________
UNM Email: _______________________________
I have included a copy of my passport or ID Card.
I have paid and included a receipt of payment.
Center for English Language & American Culture
MSC06 3850
1 University of New Mexico
Albuquerque, NM 87131, U.S.A.
+1 505.277.7540
celac.unm.edu
[email protected]