Day Telephone Number
Evening Telephone Number
Fax Number (optional)
Date of Birth (day-month-year)
Place of Birth (country, city):
Status and Visa Information
Are you NOW in the United States? Yes No
a. If your answer is yes, when did you come to the United States?
b. What type of visa do you hold?
If you are not in the United States at this moment, do you wish to be sent an I-20 for a student Visa?
If no, on which Visa do you intend to enter the United States?
Do you request Express courier service to send you an I-20 for a student Visa?
If yes, please note that an additional fee is required with your application (the amount of the fee varies depending on destination - your country and city).
I wish to book Weeks
I wish to start classes on: (Day) (Month) (Year)
I am applying for the following program at English Language School in San Diego:
Test Preparation courses
Silver program: English for 50+ Silver program: English for 50+
Please select your accommodation option for the Silver Program:
Private English courses
English plus Activities courses
Teacher Training Course Teacher Training
What is the student's present level of English?
For how long have you studied English?
Do you want us to arrange Accommodations for you?
If yes, please select one of the following options:
Host Family, single room, half-board
Host Family, single room, no meals
Studio 819 Residence Club - Private studio (small)
Studio 819 Residence Club - Private studio (large)
Do you have any allergies?
If yes, please list:
Do you require a special diet (i.e. Vegetarian)?
If yes, please specify:
Please give details of any special requirements relating to health, allergies, diet, etc.:
Do you want us to arrange airport transfer for you?
Please supply flight arrival information:
Arrival Time: (24 hour clock)
Airline and flight number:
A non-refundable application fee of US$150 and a tuition deposit of $250. The Tuition Deposit is part of the cost of your course and is deducted from the total tuition fees. The tuition deposit is not an additional cost. Please note that your application will be considered only when your payment of the enrollment fees and the tuition deposit has been received.
Upon receiving your application, application fee and deposit, we will send you a registration confirmation and invoice.
The payment of the balance of fees is due upon receipt of invoice. Your place will be confirmed only when the full payment has been received. The full payment must be paid before we can issue documentation in support of a visa application.
You may pay the balance by wire transfer, check or money order, or by credit card.
Please note that you may apply online only if you pay the application fee and the tuition deposit by credit card.
You can also print out a from your browser, fill in your application and send it by post or by fax. If you use the printable application form, you can make your payment of the enrollment fees and deposits by credit card, check or international money order or by wire transfer to our bank account.
a monospaced printable application form
Payment by Credit Card
We accept VISA and MasterCard. In this Form, we utilize the Secure Socket Layer (SSL) authentication and RC4 128 bit encryption technology. SSL encryption protects information being transmitted across the internet to our processing center.
Please charge the application fee of US $150 and a tuition deposit of US $250 to my credit card provided below.
Please charge the enrollment fees and the full payment to my credit card provided below.
Even if you select a "full payment" option, we will charge only the enrollment fee and the deposit at the time of accepting your application and will process the payment of the balance to your credit card after registering you for the program. Please also note that if you would prefer to pay the balance by credit card, a 4.5% convenience payment processing service fee will be included in the invoice. There are no any additional charges on your payment of the enrollment fee and the program deposit by credit card.
Please select credit card:
(Month) / (Year)
Card Verification Value*:
* the last three digits on the back of your credit card after the credit card number. This value protects you from online fraud by verifying that you are in possession of the card you are attempting to use.
Cardholder Billing Information:
Zip (Postal) Code
Agreement and release.
By submitting 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 have read all terms and conditions 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 Florida, USA.
Yes, I agree.
I don't agree