Seattle Language & Culture Institute Registration for International Individual Participants

This form is for residential participants who are registering as individuals. To submit a form to register as a group, please click here.

After you complete your registration, you will be sent to a page with a payment link to pay via credit card (you can also open the payment page here). If you would like to pay via bank transfer, please complete this form and then contact Ellen Frierson at for details.

First Name *
First Name
Preferred Name *
Preferred Name
Last Name *
Last Name
(Street, city/town, state/province)
Date of Birth *
Date of Birth
Phone Number
Phone Number
Parent/Gaurdian Name
Parent/Gaurdian Name
Phone Number
Phone Number
All participants are required to carry international student health insurance during their time with the Seattle Language and Culture Institute. If you would like for FIUTS to purchase insurance for the participant, please write "FIUTS" here and choose the option to add insurance to your program fee for an additional $40 USD when you make your payment. If you will be purchasing your own insurance, please include the information here and send proof of insurance to
This section should be filled out by the student participating in the Seattle Language and Culture Institute. Include number of years you have studied English in school and any other experience you have learning/studying English.