Application to Spanish Language School in La Ceiba, Honduras.

IPSA - International Partners for Study Abroad

Application
to Spanish Language School in La Ceiba, Honduras.

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 15 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, company:______________________________

___________________________________________________________________________

Emergency Contact:

Name: ________________________________________________________________

Relationship:______________________ Telephone: ________________________

Address: _____________________________________________________________

Part B. Program data:

Please check one of the following:

__Spanish Language Program with Homestay

__Spanish Language Program Only (without Homestay)

__Spanish Plus Volunteer Program

__Spanish Plus Eco Tourism Program

When would you like to start your course:

Month: ______________ Day: _____ Year: ___________

For how many weeks you want to register? Number of weeks: ________

Comments:

___________________________________________________________________________

Part C. Accomodations.

Do you require help with accommodations? __yes __no

If yes, please select the accommodations you prefer:

__Homestay

__Local Hotel:

Please give us details and your requirements, if you have selected Local
Hotel:

__________________________________________________________________________

___________________________________________________________________________

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:

A non-refundable application fee of US$75 and a Program Deposit of $200. The Program Deposit
is part of the cost of your program and is deducted from the total program fees. Please note that
your application will be considered only when your payment of the Application Fee and Deposit
has been received.

Upon receiving your application and application fee, we will send you a Confirmation and Invoice.
Please note that a full payment of tuition and accommodation fees is due upon receipt of invoice.
Your place will be confirmed only when the full payment 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
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

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.