Certification of English Language Proficiency

By an Academic Institution or English Language School

[Please note that this certification is required by the U.S. Department of State,
U.S. Code of Federal Regulations section 22 § 62.10 (a)(2).]

This is a sample form letter.

Your certification letter must be printed
on School/Institution Letterhead

Date (MM/DD/YY)

RE: Certification of English Language Proficiency for [Scholar Name: PRINT Last and First Name]

I verified that the above-mentioned scholar possesses sufficient proficiency in the English language to
participate successfully in his/her program at MSRI and to function on a day-to-day basis in the U.S.

SCHOOL OFFICIAL NAME [PLEASE PRINT]

TITLE
DEPARTMENT

SCHOOL OFFICIAL SIGNATURE