IPSA - International Partners for Study Abroad 



to Italian Art Institutes

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 224 Datura Street, Suite 1100 West Palm Beach, FL 33401, USA or by Fax to: +1 (561) 629-5983

Application Deadlines:

Fall Semester: July 1st Spring Semester November 15th June Summer Session: April 15th July Summer Session: May 10th August Summer Session: July 1st January Intersession: December 10th

Acceptance of late applications is subject to space availability.

Part A. Personal data:

First Name: ___________________ Last Name: ______________________________ Home Address: _____________________________________________________________ ___________________________________________________________________________ Telephone: (____)________________ Fax: [optional] (____)__________________ E-mail: __________________________________________________________________ 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 __ Professional/Interested Adult. Please enter your occupation: _______________________________________________________________________ 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:

Please check the location: __ Art Institute in Florence __ Art Institute in Rome __ Art Institute in Tuscania __ I want to apply for semester or summer/Jnauaury Intersession program. __ I want to apply for Study Certificate or Professional Certidicate program.

Semester or summer/Jnauaury Intersession programs

Italian Language course is mandatory for all semester programs. Please specify your Italian language level: __beginner __non-beginner If non-beginner, please specify how many semesters of Italian language you have studied: _____________________________________________________________ Non-beginners in Italian will take a placement test during the orientation session. Please check the semester or session of your choice: __FALL __SPRING __Summer 1 __Summer 2 __Summer 3 __JANUARY INTERSESSION PLEASE SELECT THE PROGRAM YOU WOULD LIKE TO ENROLL: Semester Program: __Program A. 1 course of Italian language and 4 academic or art courses __Program B. 1 course of Italian language: Superintensive Italian. __Program C. 1 course of Italian language and 2 academic or art courses. __Program D. 1 course of Italian language 1 course of Italian language Please enter the name of the courses of you choice and the name of the alternative courses if the courses of your first choice are not available: 1. _____________________________________________________ Code: ____________ Alt: ___________________________________________________ Code: ____________ 2. _____________________________________________________ Code: ____________ Alt: ___________________________________________________ Code: ____________ 3. _____________________________________________________ Code: ____________ Alt: ___________________________________________________ Code: ____________ 4. _____________________________________________________ Code: ____________ Alt: ___________________________________________________ Code: ____________ You can also add extra courses. For any extra course added you will be charged 750 Euro (3 credits). Extra courses: 1. _____________________________________________________ Code: ____________ Alt: ___________________________________________________ Code: ____________ 2. _____________________________________________________ Code: ____________ Alt: ___________________________________________________ Code: ____________ Summer Programs and January Intersession*: __PROGRAM 1: One academic or art course + Intensive Italian __PROGRAM 2: One academic or art course + Superintensive Italian __PROGRAM 3: Two academic or art courses __PROGRAM 4: One academic or art course __EXTRA NON-CREDIT COOKING COURSE __EXTRA NON-CREDIT WINE TASTING COURSE * Programs available for January Intersession: Program 2 and Program 4. Please enter the names and the courses of you choice and the the names of the alternative courses if the course of your first choice is not available: 1. _____________________________________________________ Code: ____________ Alt: ___________________________________________________ Code: ____________ 2. _____________________________________________________ Code: ____________ Alt: ___________________________________________________ Code: ____________ PLEASE NOTE THAT ONCE YOU ARRIVE IN ITALY YOU WILL NOT BE ALLOWED TO SWITCH PROGRAM Please also note: It is your responsibility to make sure your home school will grant you credits for the courses you select (alternates included), that you c onform to your school credit requirements and that you do not exceed the total number of credits allowed. We require that you provide alternative courses to your first choices.

Study Certificate or Professional Certidicate programs.

Please check the semester when you want to start your program: __FALL __SPRING __ Fine Arts Study Certificate: (2-Year Certificate) __ Interior Design Study Certificate: __ Interior Design Professional Study Certificate: __ Fashion Design Study Certificate: __ Fashion Design Professional Study Certificate: __ Jewelry Design Study Certificate: __ Jewelry Art and Design Professional Study Certificate: __ Restoration and Conservation Study Certificate: __ Restoration and Conservation Professional Study Certificate: __ Graphic Design Study Certificate: __ Graphic Design Professional Study Certificate:


Do you need accommodation? __ Yes __No If yes, what type of accomodation would you prefer? __Shared Apartment, single room __Shared Apartment, double room __Hotel 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: _______________________________________

Part C. Payment of Fees:

A non-refundable application fee of US$150 and a tuition deposit of US$250 are required with your application. The above fees and deposit are part of the cost of your program and are deducted from the total of the program fees after conversion them in Euro according to the current exchange rate for buyers. Please note that your application will be considered only when your payment of the application fee and the tuition deposit has been received. If housing service is requested, the accommodation deposit of $300.00 is also required with your application. Upon receiving your application and your payment of the required fee(s) and the tuition deposit, we will send you registration confirmation and invoice for the balance due. The balance may be paid in Euro or in U.S. Dollars. Please note that normally we must receive a full payment of the program fees at least 40 days before the commencement of your program. Payments of the application fee and deposit 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 224 Datura Street, Suite 1100 West Palm Beach, FL 33401, 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 Study Abroad International 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 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 also understand that once I have selected one of the above Semester or Summer Programs, I will not be allowed to change Program after arrival in Italy. I am aware that the Registrar reserves the right to enroll me in an alternative course should the first choice be over-enrolled, or move me to a different section in order to level course enrollment. I have read all terms and conditiones and rules and agree to follow all IPSA and study abroad host procedures and regulations. 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: ___________________ 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.