English Language Proficiency Certification Form

UCI International Center English Language Proficiency Certification Form

Scholar's Name: ____________________________________________________________________________________________________

The Department of State requires scholars to have "sufficient proficiency in the English language, as determined by an objective measurement of English language proficiency, successfully to participate in his or her program and to function on a day-to-day basis." [22 CFR 62.11(a)(2)]

Check One: Indicate how the Department has certified English proficiency for the prospective exchange visitor.

A copy of the test score is provided

Certification by a recognized English language test

? A minimum score of 550 (paper based) or 80 (internet based) on the Test of English as a Foreign Language (TOEFL)

? A score of 7 or higher on the International English Language

Testing System (IELTS)

A copy of the letter is attached

? Verifies the exchange visitor possesses English language

Certification by an academic institution or English language school

proficiency high enough to function daily within the UCI position and within the local U.S. community.

? Issued on letterhead in English within the past 6 months.

? Includes signature from school official.

PI Name: _________________________________________

Date of Interview: __________________________________

Duration of Interview: ________ minutes

The Interview Was Conducted:

In person By Videoconference By Phone

Interview Notes (required):

____________________________________________________

Certification by the Sponsoring Professor (signature

required in right column)

____________________________________________________

____________________________________________________

I declare under penalty of perjury that I have interviewed the prospective exchange visitor, and I have verified that the scholar's English language proficiency is sufficient to function daily within their UCI position and within the local U.S. community.

_____________________________ PI Signature

_____________ Date

UCI International Center Irvine, CA 92697-5255 P: 949.824.7249 F: 949.824.3090 internationalcenter@uci.edu ic.uci.edu IC Office Use Only: Date Received: __________ Advisor's Initials: ___________ Ready for Pick-Up On: _________________ | Revised On 12.2.2014

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