IPSA - International Partners for Study Abroad
Application
to English/French Language School in Ottawa, Canada.
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
40240 N. 69th Place
Cave Creek, AZ 85331, 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 5 weeks 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: ______________________________________
___________________________________________________________________________
Emergency Contact:
Name: ________________________________________________________________
Relationship:______________________ Telephone: ________________________
Address: _____________________________________________________________
Part B. Program data:
For how many weeks you want to register: Number of weeks: ______
I Wish to Start Classes on ___(Day) _____________ (Mo) ______(Year)
Which course would you like to study?
English and French for Adult Learners
__Full-time Intensive English Course:
(30 lessons a week, 9:00 a.m. to 12:15 pm and 1:15 pm to 3:00 pm)
__Part Time English Course Morning
(20 lessons per week, 9:00 a.m. to 12:15 pm)
__Part Time English Course Afternoon
(10 lessons per week, 1:15 pm to 3:00 pm)
__English or French Private Classes (One-to-One):
Please enter number of private lessons per week: ________
(Min. 10 lessons/General ESL)
__English or French Semi Private Classes or Small Group Classes:
Please select the language: __ English __ French
Please enter number of lessons per week: ________
(Min. 10 lessons)
Our Semi-Private (2-to-1) and small group ESL classes are specifically
designed for small corporate groups or friends who have the same level of
English comprehension.
__ TOEFL preparation (20 lessons)
__ TOEIC preparation (20 lessons)
__ TFI preparation (20 lessons)
__Intensive Group French (2 weeks minimum, 35 lessons a week)
__Ottawa & Toronto Experience
__English Teacher Training: TESL or TEFL
__French Teacher Training: EFLS
__Fifty Plus (for mature students)
Please select the activity package if you are interested in:
__ Activity package 1 __ Activity package 2 __ Activity package 3
__Optional Trips: __1 day __2 days + 1 night __3 days + 2 nights
English and French Junior Programs:
Please select the language: __ English __ French
Summer Camps:
__English or French Day Camp
__English or French Camp with Homestay
__English or French Camp with Residence
Optional trips: __Yes __No
__ Parent & Child Combo (English or French)
__International Academic Year (for students aged 14 Ð 18)
Summer School in Ottawa
__Science - Ecology and the Environment
__Theatre Arts - Shakespeare through Pop Culture
__Winter Break Camps
What is your present level of English or French?
__Beginner __Elementary __Low Intermediate __Intermediate __Advanced
Part C. Accomodations.
Do you require help with accommodations? __yes __no
If yes, please select the accommodations you prefer:
__Homestay: __Full Board (3 meals per day) __ Breakfast only
__Residence Accommodation
If you require accommodations, please also fill in below:
Are you a smoker? __yes __no
If you have a special diet, please specify:
___________________________________________________________________________
If you have allergies, please specify:
___________________________________________________________________________
If you have other requirements, please specify
___________________________________________________________________________
___________________________________________________________________________
Part D. Payment of Fees:
Please note that your application will be considered only when your
payment of the non-refundable Application Fee of US$80 and Tuition Deposit
of US$200 has been received.
Upon receiving your application and your payment of the required fee(s)
and the tuition deposit, we will send you a registration confirmation and
invoice for the balance in Canadian Dollars converted in U.S. Dollars or
in Euro according to the current exchange rate for buyers communicated
by IPSA on the invoice date. The balance must be paid in U.S. Dollars or
in Euro. Please note that a full payment of the balance is due upon the
receipt of invoice. Your place will be confirmed only when the full payment
has been received.
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
40240 N. 69th Place
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% convenient payment processing
service fee will be included in the invoice. There are no any additional
charges if you pay the application fee and the tuition deposit by credit card.
Comments: _________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Part E. 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 Study Abroad International 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 assume all risks and responsibilities
and discharge IPSA and the study abroad program host and all their officers,
agents and employees from and against any and all claims of damage to
personal property or personal injury which may result from my enrollment and
participation in the study abroad program host courses, excursions, and/or
on and off-campus activities. I have read all terms and conditiones and
rules and agree to follow all IPSA and study abroad host procedures and
regulations. This Agreement will be effective when my application is
accepted by IPSA and shall be governed by the laws of the State of Arizona.
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.
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