IPSA - International Partners for Study Abroad
Application
to Florence Academy of Music, Art and Language, Italy
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 your application and a full payment
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: ______________________________________
___________________________________________________________________________
Emergency Contact:
Name: ________________________________________________________________
Relationship:______________________ Telephone: ________________________
Address: _____________________________________________________________
Part B. Program data:
I Wish to Start Classes on ____(Day) _______________(Month) ________(Year)
I Wish to Book: ____ Weeks
Which course would you like to study?
__Standard Italian Language Course (20 lessons per week)
__Standard Italian Language Course (10 lessons per week)
__Intensive Italian Language Course (26 lessons per week)
__Italian plus Music (Intensive - Music) (Standard Italian + 2 Music lessons/wk)
__Italian plus Music (Intensive - Music) (Standard Italian + 4 Music lessons/wk)
__Italian plus Music (Intensive - Music) (Standard Italian + 6 Music lessons/wk)
__Italian plus Art (Intensive Art) (Standard Italian + 2 Art lessons/wk)
__Italian plus Art (Intensive Art) (Standard Italian + 4 Art lessons/wk)
__Italian plus Art (Intensive Art) (Standard Italian + 6 Art lessons/wk)
__Italian plus Culture (Intensive - Culture) (Standard Italian + 2 Culture lessons/wk)
__Italian plus Culture (Intensive - Culture) (Standard Italian + 4 Culture lessons/wk)
__Italian plus Culture (Intensive - Culture) (Standard Italian + 6 Culture lessons/wk)
__Group Combined Course (Standard Italian + 10 Individual lessons per week)
__Group Combined Course (Standard Italian + 15 Individual lessons per week)
__Group Combined Course (Standard Italian + 20 Individual lessons per week)
Music Courses (10 lessons minimum):
__History of Music. I want to book ___lessons of 45 minutes each
__History of Melodrama. I want to book ___lessons of 45 minutes each
__Opera Directing. I want to book ___lessons of 45 minutes each
__Opera Libretti. I want to book ___lessons of 45 minutes each
__Vocal Technique. I want to book ___lessons of 45 minutes each
__Vocal Music of the Middle Ages, the Renaissance and the Baroque.
I want to book ___lessons of 45 minutes each
__Interpretation of Chamber Lyrics. I want to book ___lessons of 45 minutes each
__Neapolitan Song. I want to book ___lessons of 45 minutes each
__Group singing. I want to book ___lessons of 45 minutes each
__Diction for Singers. I want to book ___lessons of 45 minutes each
__Piano Accompaniment A. I want to book ___lessons of 45 minutes each
__Piano Accompaniment B. I want to book ___lessons of 45 minutes each
__Piano. I want to book ___lessons of 45 minutes each
__Musical Instruments. I want to book ___lessons of 45 minutes each
Art Courses (10 lessons minimum):
__Watercolor. I want to book ___lessons of 45 minutes each
__Oil Painting. I want to book ___lessons of 45 minutes each
__Sketches of Florence. I want to book ___lessons of 45 minutes each
__Figure Drawing. I want to book ___lessons of 45 minutes each
__Ceramics. I want to book ___lessons of 45 minutes each
__Sculpture. I want to book ___lessons of 45 minutes each
__Appraisal of Antiques. I want to book ___lessons of 45 minutes each
__Photography. I want to book ___lessons of 45 minutes each
Culture Courses:
__Art History
__History of Literature
__History of Italian Cinema.
__History of Contemporary Italy.
__History of Italian Theater
__Short course 1
__Short course 2
Courses for professionals:
__Italian for Tourism
__Italian for Business and Commerce
__Preparation Courses for CILS, CELI, DELI and DALI Certifications.
__Wine Appreciation.
__Italian Cuisine
__Individual (One-to-One) Italian Language Course
Please check a number of individual lessons per day:
__2 __3 __4 __6 __8
Yearly Courses:
__Standard
__Intensive - linguistic
__Intensive - music with __2 _4 __6 Music lessons per week
__Intensive - art. with __2 _4 __6 Art lessons per week
__Intensive - culture with __2 _4 __6 Culture lessons per week
I have studied Italian for __Years at a ___________________________________
(type of school e.g. high school, university, private language school)
What is your present level of Italian?
__Beginner __Elementary __Low Intermediate __Intermediate __Advanced
Accomodations:
Do you need accommodation? __ Yes __No
If yes, what type of accomodation would you prefer?
__Private Apartment
__Single room in Student Apartment
__Double Room in Student Apartment
__Single Room with family with breakfast
__Double Room with family with breakfast
__Single Room with family with halfboard
__Double Room with family with halfboard
__Hotel or Pension, Single room
__Hotel or Pension, Double room
Please select a category of your accommodations:
__Bronze star __Silver star __Gold Star
Do you smoke? __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 a non-refundable Application Fee of US$80 and tuition deposit of US$200
has been received. The tuition deposit is a part of the cost of your course
and is deducted from the total tuition fees after conversion in Euro
according to the current exchange rate.
The full payment of the program fees is due due upon the receipt of invoice.
Your place will be confirmed only when the full payment has been received.
Payments of the application fee and deposit must be made in U.S. dollars and
payable through U.S. banks.
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 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 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.
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