IPSA - International Partners for Study Abroad 

                       

Application

                   

to English Language School in San Diego


                Please print out this form from your browser, 
                complete (print or type) and sign the Apllication 
                               and send it by mail to:

                               IPSA Enrollment Center 
                               13832 N 32nd Street, Suite 151
                               Phoenix, AZ 85032, USA

                               or by Fax to: +1 (602) 942-6734


                           Application Deadlines

    Normally, we must receive a complete set of application documents
    and fees no later than 30 days (15 days - if you do not need I-20)
    before the program starts.


Part A. Personal data:


First Name: ___________________  Last Name:  ______________________________

Home Address: _____________________________________________________________

___________________________________________________________________________

Telephone: (____)________________  Fax: [optional] (____)__________________

E-mail: [optional] ________________________________________________________

Date of Birth: (month/day/year) _____/____/___________    __ Male  __Female

Place of Birth (country, city):  __________________________________________

Nationality:  _________________  Citizenship (country): ___________________

Native language: __________________

Other languages, if any: __________________________________________________

    I am a college    __ freshman    __ sophomore    __ junior    __ senior

    __ Graduate Student    __ High School Senior        __ Interested Adult

    __ Professional.  Please enter your profession: _______________________

If you are a graduate or undergraduate student, please provide the 
following information: 

Current college/university/graduate school:  ______________________________

___________________________________________________________________________

Major field of study: _____________________________________________________

Address of your college, university: ______________________________________

___________________________________________________________________________


Insurance:


It is advisable that students have health insurance while residing or 
traveling in the United States. The insurance carrier in the student's home 
country can provide this coverage, or short term health coverage through an 
American company can be arranged. If insurance is needed upon arrival, the 
school will provide names of companies that will insure students for 12-180 
days.  

My insurance company is:  _________________________________________________ 
 
Policy Number: ____________________________________________________________ 


Emergency Contact:


   Name:   ________________________________________________________________

   Relationship:______________________  Telephone: ________________________
 
   Address:   _____________________________________________________________


Status and Visa Information:


Are you NOW in the United States?  __Yes  __No 
a. If your answer is yes, when did you come to the United States?

   Month:___________________  Year: _______

b. What type of visa do you hold?  ________________________________________

If you are not in the United States at this moment, do you wish to be sent 
an I-20 for a student Visa?  __Yes   __No

a. If no, on which Visa do you intend to enter the United States? _________

b. Please note that Non-immigrant alien students' documents (I-20) are  
provided for students taking a minimum of 20 lessons per week. 


Part B. Program data:


I Wish to Book ____ weeks

I Wish to Start Classes on ____(Day) _______________(Month)  ________(Year) 

Please check the course:

Group courses 

__Intensive English  __15 lessons/week __20 lessons/week __25 lessons/week

__ESL Literacy  __15 lessons/week __20 lessons/week __25 lessons/week

__American Culture  __20 lessons/week __25 lessons/week

__English & Volunteering  __20 lessons/week __25 lessons/week

__Business English  __20 lessons/week __25 lessons/week

__Travel and Hospitality  __20 lessons/week __25 lessons/week


Test Preparation courses 

__GMAT Preparation  __15 lessons/week __20 lessons/week

__MELAB Preparation  __15 lessons/week __20 lessons/week

__TOEFL Preparation  __15 lessons/week __20 lessons/week

__TOEIC Preparation  __15 lessons/week __20 lessons/week


Private English courses 

__Private English  __private lessons per week (min. 10 per week)

__Legal English  __private lessons per week (min. 10 per week)

__Conversation Workshops  __private lessons per week (min. 12 per week)

__Accent Reduction  __private lessons per week (min. 12 per week)

__Writing Strategies  __private lessons per week (min. 12 per week)

__Grammar and Sentence  __private lessons per week (min. 12 per week)

__Speech Preparation and Presentation __private lessons per week (min. 12 per week)

__Audio Conferencing - 30 min session __private lessons per week (min. 10 per week)

__Audio Conferencing - 60 min session __private lessons per week (min. 10 per week)

__Video Conferencing - 30 min session __private lessons per week (min. 10 per week)

__Video Conferencing - 60 min session __private lessons per week (min. 10 per week)


English plus Activities courses 

__English and Tennis

__English and Golf

__English and Water Polo

__English and Surfing

__English and Sea World

__Parent and Child Combo


Teacher Training Course 

__Teacher Training


Silver program for Adults 

__Silver program: English for 50+ 


I have studied English for __Years at a ____________________________________ 

____________________________________________________________________________
(type of school e.g. high school, university, private language school) 


What is your present level of English? 

__Beginner

__Upper beginner

__Pre-Intermediate

__Lower Intermediate

__Intermediate

__Upper Intermediate

__Pre-Advanced

__Advanced 


Accomodations:


Do you need accommodation? __ Yes   __No 

If yes, what type of accomodation would you prefer?

__Host Family, single room, half-board

__Host Family, single room, no meals

__Vantaggio Suites Residence Club - Shared Studio

__Vantaggio Suites Residence Club - Private studio (small)

__Vantaggio Suites Residence Club - Private studio (large)

__Studio 819 Residence Club - Private studio (small)

__Studio 819 Residence Club - Private studio (large) 

Do you smoke? __Yes  __No       Do you like pets? __Yes __No
  
Do you like children? __Yes   __No  

Do you have allergies to food/animals? List: _______________________________

____________________________________________________________________________
  
Accommodation will be arranged subject to availability.
 
Accomodation Arrival date: ________________  Checkout date: ________________

Do you require airport pickup?   ___Yes  __No

**Arrival date: ____________________________   **Time: _____________________  

**Airline _________________________   **Flight Number: _____________________
 
**Without this information, airport pickup services can not be guaranteed. 


Part C. Payment of Fees:

 

Please note that your application will be considered only when your payment 
of the non-refundable application fee of $150.00, accommodation placement fee
(if required) and the tuition deposit in the amount of $250.00 has been received. 


All payments must be made in U.S. dollars and payable through U.S. banks. 
Any collection charges will be the applicant's responsibility. Checks or 
international money orders drawn on foreign banks will not be accepted. 

Please select one of the following payment options: 


1. __Please find enclosed a certified check/money order for the application
     fee and the tuition deposit.

Cashiers Checks or international money orders must be made payable to IPSA. 

Please send a check or international money order with your application to:

IPSA
13832 N 32nd Street, Suite 151
Cave Creek, AZ 85331, USA


2. International Wire Transfers

You can make your payment by wire transfer. Just fax us your application 
and request our account and bank information:

___I want to pay the application fee and the tuition deposit by wire transfer.
   Please send me instructions on  how  to  send  the  wire  transfer to your 
   bank account.


3. Payment by Credit Card: 

Please select credit card:  ___VISA    ___MasterCard

Credit Card No: _____________________ Expiration Date: Month ____ Year_____

Card Verification Value: ___________  (The last three digits on the back of 
your credit card after the credit card number.)


Cardholder Name: __________________________________________________________

Street Address:  __________________________________________________________

City:______________________   State:___________________ Zip Code:__________


I authorize to charge the above credit card account:

___ application fee and deposit   ___ application fee and full payment due

Even if you select a "full payment" option, we will charge the application
fee and the tuition deposit at the time of  accepting your application and 
will process the payment of the  balance  to your  credit card  only after 
registering you for the course.  Please also note that if you would prefer 
to pay the balance by credit card, a  4.5% payment processing  service fee 
will be included in the invoice.
      

Comments: _________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________


Part D. Agreement and release.


By signing this Application, I certify the above information is complete and 
correct. I understand  that  my misrepresentation may result in my expulsion 
from the program. I  acknowledge  that the terms and conditions appearing on 
the web  site  constitute  part  of  my agreement with IPSA and study abroad 
program host (university, college, language school, or other institution and
or  organization),  including  sections  concerning  responsibility, health, 
refunds,  changes  in  dates,  accommodations,  courses  and  billing of the  
selected options. I have read the Agreement and agree to follow all IPSA and  
study  abroad  host  procedures.  This Agreement  will  be effective when my  
application  is  accepted  by IPSA  and shall be governed by the laws of the 
State of Arizona, USA. 



Applicant's Signature ______________________       Date: ___________________


Parent's/Legal Gardian's  
Signature if applicant  
is under 18 years     ______________________       Date: __________________




Please do not forget to make a copy of this completed and signed application
for your records and enclose your payment of the application fee and deposits.