IPSA - International Partners for Study Abroad
Application
to Language School in Montevideo, Uruguay
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 tuition fees no later than 30 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 __ High (Secondary) School Student
University student: __ freshman __ sophomore __ junior __ senior
__ Graduate Student __ Professional
Please enter your profession: _________________________________________
If you are a high (secondary) school student, please provide the following
information:
Name(s) and year(s) of last schools attended (and certificate(s) if any:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
(Please enclose a School certificate for last year)
Major field of study: _____________________________________________________
Address of your school, college, university, or company:
___________________________________________________________________________
Emergency Contact:
Name: ________________________________________________________________
Relationship:______________________ Telephone: ________________________
Address: _____________________________________________________________
Part B. Program data:
I Wish to Start Classes on ____(Day) _______________(Month) ________(Year)
Please check the course you would like to study:
__ Spanish Intensive Course, 20 lessons a week (course A)
__ Spanish Super Intensive Course, 30 lessons a week (course B)
__Private Spanish Course __ private lessons per week (course c)
__Business Spanish (course D)
__Spanish for Children (course E)
__Spanish for Seniors (course F)
__Spanish + Tennis (course G)
__Spanish + Sailing (course H)
__Spanish + Windsurfing (course I)
__Spanish + Tango (course J)
__Spanish + Diving (course K)
__Spanish + Golf (course L)
I have studied the language for __Years at a ______________________________
(type of school e.g. high school, university, private language school)
What is your present level of Spanish?
__Beginner __Intermediate __Advanced __Superior
Accomodations:
Do you need accommodation? __ Yes __No
If yes, what type of accomodation would you prefer?
__Homestay with single room
__Student Residence, single room/shared bath
__Student Residence, double room/shared bath
__Student Residence, Single room with private bathroom
__Student Residence, Double room with private bathroom
__Apartment
Accommodation will be arranged subject to availability.
Airport pickup:
Do you need airport pickup? __ Yes __No
If yes, what type of accomodation would you prefer?
Arrival Date: __ (Day) _______ (Month) ____ (Year)
Arrival Time: _______ (24 hour clock)
Arrival Location: _________ (airport)
Airline and 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 US $80.00, and tuition
deposit of $200 has been received. The Program Deposit is part of the cost
of your course and is deducted from the total program fees.
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
and course registration 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:
___ enrollment fees 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 this web site constitute part of my agreement with IPSA and
study abroad program host (university, college, language school, or other
institution or organization), including sections concerning responsibility,
health, refunds, changes in dates, accommodations, courses and billing of
the selected options. I have read this Agreement and agree to follow all
IPSA and study abroad host procedures. This Agreement will be effective
when my application i s 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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