Clergy and Religious Summer English Institute Application

Complete the following  form to apply to the Summer English Institute.

NOTE: Spouses of married clergy may also enroll for courses.
* Denotes Required Field

Last Name*:   First*:   MI:   

Native Country:  

Anticipated arrival date:  

Native Language(s):    

Current Address including Country:   

Telephone Number (including Area Code):  

E-mail Address* 

Please answer the following questions to give us a general idea of your educational background and current English proficiency level:
  1. Have you ever received formal English training/classes in the past? 
  2. If you answered "Yes" for question #1, how long have you studied English?  
  3. What is the highest degree you have earned?   and what was your area of Study/Major?    (Send copies of any diplomas/ final transcripts**) 
  4. Highest TOEFL or IELTS Score:   Date Taken:   (Send copies of any TOEFL/IELTS Certificates/Score Reports**) 
  5. If you are living abroad, have you visited the United States before?    
  6. Religious Affiliation/Order:  
  7. Diocese/Parish Affiliation within the U.S. (if any):   
If sending supporting documentation mentioned in questions 3 and 4 above, send to:

**La Roche University
    Clergy and Religious Summer English Institute
    9000 Babcock Boulevard
    Pittsburgh, PA 15237 USA