APPLICATION &ENROLLMENT AGREEMENT
Period Covered By The Enrollment Agreement

1 - 08 - 24 to 01 - 10 - 25

Accredited by*MENTOR LANGUAGE INSTITUTE
Westwood*MENTOR LANGUAGE INSTITUTE
Hollywood

10880 Wilshire Blvd., Suite 122
Los Angeles, CA 90024
310-887-0777
Fax: 310-593-2499
info@mliesl.edu

7080 Hollywood Blvd. Suite 314
Los Angeles, CA 90028
323-870-7102
Fax: 323-488-9748
hollywood@mliesl.edu

www.mliesl.edu
MLI Application & Enrollment Agreement
Page 1 of 5

*Institution addresses

Last Revised 2/20/2024

Please check your preferred campus of instruction:
Westwood
Hollywood
10880 Wilshire Blvd., #122, Los Angeles, CA 90024 7080 Hollywood Blvd., #314, Los Angeles, CA 90028

Student Information:___OS___ Program Change___ TF___ Renewal___ COS
Office Use Only

Family Name (Surname):First (Given) Name:

Middle Name:Country of Birth:

Date of Birth(month/day/year):Country of Citizenship:

Sex:

City/Province of Birth:

MaleFemale

Email Address:

Home Country Address:
Street Number __________________________________________________________________________
City __________________________________________________ State ___________________________
Postal Code ____________________________ Country ________________________________________
Phone (______) _____________________________ Fax/Cell (______) _____________________________USA Address:
Street Number __________________________________________________________ Apt. # ________
City ________________________________ State ________________ Zip Code _____________________
Phone (______) _____________________________ Fax/Cell (______) _____________________________
Person to Notify in Case of an Emergency: (In the US)
Name _____________________ Relationship _______________ Telephone (_____) __________________
Address ________________________________________________________________________________
Program:_ ESL
Hours required
1,728
to complete:
Program:_ TOEFL®
Hours required
Preparation
to complete:
648

Vacation ESL
1,536

Conversation
1,728

TOEFL® and University
Preparation
648

Business Plus
Duolingo
TOEIC®
432
432
IELTS™
Private lesson
432
Number ofhours:________________

Combination:

No Combination

2 Programs

Class Schedule:

MorningAfternoon

Evening

Course Length:

12 Weeks

4 Weeks

Other _______________________

Private Lesson

Course Starting Date: __________________
Scheduled Completion Date: __________________(month/day/year)
1) LOA: _________to_________(month/day/year)
New schedule Completion Date: _______________ X___
2) LOA: _________to_________
Do you need an I-20?
Yes*
No
New schedule Completion Date: _______________ X___*All I-20 applications must be accompanied by a $150.00 non-refundable, and a financial statement verifying your ability to meet expenses. SEVIS fee may also apply.
(Estimated expenses per school year: $18,000.00 USD)
Please indicate how you would like us to deliver your I-20:
Express Mail (additional fee of $120.00 will apply)
In Person
How did you hear about Mentor Language Institute? (Please check all that apply)
FriendMLI Student : Name:_____________________
Agent : Name: __________________
InternetGoogleBing
SNS :Instagram
FacebookYahoo
Other________________
YoutubeOther:____________TOEFL, and TOEFL iBT are registered trademarks of Educational
Testing Service (ETS) in the United States and other countries.

MLI Application & Enrollment Agreement
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Last Revised 2/20/2024

WITHDRAWAL FROM COURSE:
You have the right to withdraw from a course of instruction at any time. A withdrawal can take place either
by written notice provided by you to the school you are attending or by your conduct, including but notnecessarily limited to, your lack of attendance.
STUDENT’S RIGHT TO CANCEL:
You have the right to cancel this enrollment and obtain a refund of charges paid through attendance at thefirst class session, or the seventh day after enrollment date ___________________, whichever islater. "Cancellation" is defined as: any voluntary change in enrollment or request for refund prior toenrollment.
REFUND POLICY:
You shall be refunded 100% of the amount paid for institutional charges, less both a $150 non-refundable
Processing fee and the $120 shipping and handling fee (if MLI processed the mailing of your I-20), if noticeof cancellation is made through attendance at the first class session or the seventh day after enrollment,
whichever is later.
If Mentor Language Institute cancels a program subsequent to a student’s enrollment, all fees will berefunded.
If after the above cancellation deadline, the refund policy for students who have completed 60 percent orless of the period of attendance shall be a pro rata refund, less a $150 non-refundable Processing fee, $120
shipping and handling fee (if applicable) and the STRF fee.
Under California law, if the student withdraws after using more than 60% of the class hours paid for, norefund will be issued.
60% of your class hours paid will be on ____/____/____

Student’s Initials: ______________

1) Due to LOA, 60% of your class hours paid will be on ____/____/____ Student’s Initials: ____________
2) Due to LOA, 60% of your class hours paid will be on ____/____/____ Student’s Initials: ____________
Upon cancellation, withdrawal, termination or completion of enrollment, any refund due the student will bedetermined and will be paid within 45 days after the date of determination.
If your enrollment was facilitated by an authorized MLI overseas agent, the refund shall be made to theagent. However, the processing of any refund may be governed by the contractual agreement between you
and the agent. You are advised to consult with your agent prior to entering into this enrollment agreement
should you have any questions.
LOANS:
If you have received federal student financial aid funds, you are entitled to a refund of moneys not paid fromfederal student financial aid program funds.
If you obtain a loan to pay for an educational program, you will have the responsibility to repay the fullamount of the loan plus interest, less the amount of any refund.
If the student is eligible for a loan guaranteed by the federal or state government and the student defaults
on the loan, both of the following may occur:(1) The federal or state government or a loan guarantee agency may take action against the student,
including applying any income tax refund to which the person is entitled to reduce the balance owed
on the loan.
(2) The student may not be eligible for any other federal student financial aid at another institution orother government assistance until the loan is repaid.

MLI Application & Enrollment Agreement
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Last Revised 2/20/2024

STUDENT TUITION RECOVERY FUND:
The State of California established the Student Tuition Recovery Fund (STRF) to relieve or mitigate economic
loss suffered by a student in an educational program at a qualifying institution, who is or was a Californiaresident while enrolled, or was enrolled in a residency program, if the student enrolled in the institution,
prepaid tuition, and suffered an economic loss. Unless relieved of the obligation to do so, you must pay thestate-imposed assessment for the STRF, or it must be paid on your behalf, if you are a student in an
educational program, who is a California resident, or are enrolled in a residency program, and prepay all orpart of your tuition.
You are not eligible for protection from the STRF and you are not required to pay the STRF assessment, ifyou are not a California resident, or are not enrolled in a residency program.
NOTICE CONCERNING TRANSFERABILITY OF CREDITS AND CREDENTIALS EARNED AT OUR
INSTITUTION:
The transferability of credits you earn at Mentor language Institute (MLI) is at the complete discretion of an
institution to which you may seek to transfer. Acceptance of the diploma, or certificate you earn in___________________________________is also at the complete discretion of the institution to which you
may seek to transfer.
If the diploma, or certificate that you earn at this institution are not accepted at the institution to which youseek to transfer, you may be required to repeat some or all of your coursework at that institution. For thisreason you should make certain that your attendance at this institution will meet your educational goals.
This may include contacting an institution to which you may seek to transfer after attending Mentor language
Institute (MLI) to determine if your diploma or certificate will transfer.
At this time, Mentor language Institute offers non-credit courses and therefore does not recognize any
credits earned at other institutions in courses of ESL study or through challenge examinations andachievement tests.
Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School
Performance Fact Sheet, which you are encouraged to review prior to signing this agreement. These
documents contain important policies and performance data for this institution. This institution is required tohave you sign and date the information included in the School Performance Fact Sheet relating to completion
rates, placement rates, license examination passage rates, and salaries or wages, and the most recent three-year cohort default rate, if applicable, prior to signing this agreement.
Student’s Initials:_________________
I certify that I have received the catalog, School Performance Fact Sheet, and information regarding
completion rates, placement rates, license examination passage rates, and salary or wage information, andthe most recent three-year cohort default rate, if applicable, included in the School Performance Fact sheet,and have signed, initialed, and dated the information provided in the School Performance Fact Sheet.
Student’s Initials: ________________MLI Application & Enrollment Agreement
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Last Revised 2/20/2024

Fees

Description/Note(please check if applicable) Amount

Processing Fee$150; Non-Refundable$_____________

Textbooks / Materials Fee

Depends on Course (usually $90-$219)$_____________

Shipping & Handling$120; Non-Refundable$_____________ID Card Fee Renewal$5$_____________SEVIS Fee$350; Non-Refundable after paid to SEVP$_____________

Student Tuition Recovery Fund
Non-Refundable; depend on program
ESL or Vacation ESL: $47.50 ; Conversation: $27.5 ; IELTS™：$12.50
TOEFL® Preparation: $20 ; Business Plus TOEIC®: $7.5
TOEFL® and University Preparation: $10; Duolingo：$12.50

included in tuition

Other (Please Explain)$_________________________________________________

FEES SUBTOTAL:$_____________

Tuition for _______________ for _______________ weeks (see Tuition Chart)
level/program# of weeks enrolled$_____________TOTAL CHARGES DUE FOR THE CURRENT PERIOD OF ATTENDANCE:$_____________

Deposit- $___________TOTAL CHARGES THE STUDENT IS OBLIGATED TO PAY UPON ENROLLMENT:$_____________

Payment in Full Election (for students enrolling in classes for 4 months or longer)
I agree to pay the full tuition of _____________ to take advantage of the offered discount.
Student’s Initials: ________________All fees can be paid by cash, credit card, personal check, international or postal money order, traveler’scheck, cashier’s check, and direct wire transfer (ask for details). Please make checks payable to:
MENTOR LANGUAGE INSTITUTE
ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM
The estimated total charges for each program (when paid in full) would not exceed the amount listed below
plus the “Fees Subtotal” above.
ESL (96 weeks): $19,296 | TOEFL® (36 weeks): $7,524 | Duolingo (24 weeks): $5,208
Conversation WW (96 weeks): $10,998 , Conversation HW (96 weeks): $10,612 | Vacation ESL (96weeks): $19,296 | Business Plus TOEIC® (24 weeks): $2,969 | IELTS™ (24 weeks): $5,208 | TOEFL®
and University Preparation (36 weeks): $4,289
Any questions a student may have regarding this enrollment agreement that have not been satisfactorily
answered by the institution may be directed to the Bureau for Private Postsecondary Education at:
Physical Address: 1747 N. Market Blvd., Suite 225, Sacramento California, 95833
P.O. Box 980818, West Sacramento, CA 95798-0818
Website: www.bppe.ca.gov
Toll Free Number: 1 (888) 370-7589
Fax Number: (916) 263-1897
Complaints:
A student or any member of the public may file a complaint about this institution with the Bureau for Private Postsecondary Education by calling 1 (888) 370-7589 or by completing a complaint form, which can beobtained on the bureau's Internet Web site www.bppe.ca.gov.
This enrollment agreement is legally binding when signed by the student and accepted by the institution.
I understand that this is a legally binding contract. My signature below certifies that I have
read, understood, and agreed to my rights and responsibilities, and that the institution's cancellation and refund policies have been clearly explained to me.
If I am unable to understand in English, I have had all terms and conditions, and the cancellation and refund policy explained to me in a language I am fluent in.
____________________________________
Student’s Signature____________________________________
Date (Month / Day / Year)____________________________________
Signature of Admissions Officer____________________________________
Date (Month / Day / Year)

MLI Application & Enrollment Agreement
Page 5 of 5

Last Revised 2/20/2024