IPSA - International Partners for Study Abroad
Application
to Greek Language School in Larissa, Greece
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 completed application and fees
no later than 40 days 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: ______________________________________
___________________________________________________________________________
What is your present level of Modern Greek?
__Beginner __Elementary __Low Intermediate __Intermediate __Advanced
Emergency Contact:
Name: ________________________________________________________________
Relationship:______________________ Telephone: ________________________
Address: _____________________________________________________________
Part B. Program data:
When would you like to start your course:
Month: ______________ Day: _____ Year: ___________
Which course would you like to study?
Winter Courses:
__Mini-group regular course (10 lessons per week, 8 weeks)
__Mini-group intensive course(20 lessons per week, 4 weeks)
I want to register for ___ 8- or 4-week mini-group sessions.
__Private course 1 (2 lessons daily, Monday - Friday)
__Private course 2 (3 lessons daily, Monday - Friday)
__Private course 3 (4 lessons daily, Monday - Friday)
__Private Immersion course (8 lessons daily, Monday - Friday)
I want to register for ___ weeks of private courses.
Accomodation Requirements:
_________________________________________________________________________
_________________________________________________________________________
Summer Courses:
__Summer Holiday Program with the Hotel Accommodation
Please select a number of weeks for the Summer Holiday Program:
__1 week __2 weeks __3 weeks
Please select a type of accommodation during the Summer Holiday Program:
__Double Room __Double Bungalow
__Single Room __Single Bungalow
__Special Camping Holiday Program
Please select a number of weeks for the Summer Holiday Program:
__2 weeks __3 weeks
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Airport transfer:
Do you need airport transfer? __Yes. __No.
If yes, please provide your flight arrival information:
Airport of arrival: __ Athens airport __Thessaloniki airport
Arrival Date: _________________ Arrival Time: __________________________
Airlines: _______________________________________ Flight number: ________
Departure city: _________________________________
Part C. Payment of Fees:
Please note that your application will be considered only when your
payment of the non-refundable Application Fee of 60 USD and the Program
Deposit of 200 USD has been received.
Please also note that we must receive a full payment of tuition and
accommodation fees (a balance due) at least 40 days before the commencement
of your program.
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
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% 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.
|