IPSA - International Partners for Study Abroad
Application
to Study Abroad Center in Taichung, Taiwan
Mandarin Chinese Language Program
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
We also need to receive the following:
1. A copy of Diploma or any certificate achieved in education: High school,
college, university, etc.
2. HIV Test Result (within the past 6 months)
3. A copy of passport
4. 4 (four) photos (passport size)
Application Deadlines
Normally, we must receive a complete set of application documents
and a full payment no later than 30 days before the program starts.
Acceptance of late applications (arrival within 30 days) is subject
to space availability and a last minute booking supplement of US$60
Please notify us by e-mail (admissions@studyabroadinternational.com)
as soon as your send your application materials and payment by post.
We recommend to send these materials by Express or Priority Mail,
so it will be possible to track your package.
Upon receiving your application and application fee, we will send
you a Course Confirmation and Invoice. Please note that we must
receive a full payment and the above mentioned additional documents
BEFORE we issue an Official Letter of Acceptance, which you need to
apply for your visa to Taiwan.
Part A. Personal data:
First Name: ___________________ Last Name: ______________________________
Middle Name: __________________ Chinese 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. Please enter your occupation: ____________________
__ 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: _____________________________________________________
Work/Study Address: _______________________________________________________
___________________________________________________________________________
Insurance:
It is advisable that students have health insurance while residing or
traveling in Taiwan. The insurance carrier in the student's home country
can provide this coverage. The School now requires all students to have
health insurance. You must show proof of this before starting classes, or
we can offer this service.
__I want to join the health insurance provided by the School
__I have the health insurance valid in Taiwan
My insurance company is:
___________________________________________________________________________
Policy Number: ____________________________________________________________
Relative or friends in Taiwan (if any):
Name: __________________________________________________________________
Occupation: ____________________________________________________________
Relationship: ______________________ Telephone: _______________________
Address: _____________________________________________________________
Emergency Contact:
Name: ________________________________________________________________
Relationship:______________________ Telephone: ________________________
Address: _____________________________________________________________
Part B. Program data:
When would you like to start your program?
__1st Quarter (September)
__2nd Quarter (December)
__3rd Quarter (March)
__4th Quarter (June)
Approximately how long do you intend to study at our Center?
__1 Semester (Quarter) __2 Semesters (Quarters) or more
Which schedule of classes do you prefer?
__morning __afternoon __evening
Do you require our optional English Teaching Job finding service?
__Yes __No If yes, Please enclose your resume or cv.
Chinese Learning Experience:
Have you ever studied Chinese before? __Yes __No
If yes, how long have you studied and where?
I have studied Chinese for ___ years at a
___________________________________________________________________________
(name of school)
Did you study standard or simplified Characters?
__Standard __Simplified __Both
Did you study Pinying, Yale or Mandarin Phonetic system?
__Pinying __Yale __Mandarin Phonetic system
What study material have you used before? Name of the book:
___________________________________________________________________________
What is your reason for learning Mandarin and what level do you intend to
reach? Which is more important for you: Reading, Writing or Speaking?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Part C. Payment of Fees:
Please note that your application will be considered only when your payment
of the non-refundable Application Fee of 75 USD and the tuition deposit of
$200 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. Certified
checks or 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
1746 E. Winchcomb Dr.
Phoenix, AZ 85022, 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 don't forget to make a copy of this completed and signed application
for your records and enclose your payment and the above mentioned materials.
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