IPSA - International Partners for Study Abroad

Teaching Center in San Francisco, California, USA.
CELTA Course
Online Secure Application Form.



I wish to apply for a place on the Cambridge RSA CELTA course starting on:

First Choice: Second Choice:

I wish to apply for a place on the Cambridge RSA DELTA course starting on:

Personal details:


Mr/Mrs/Ms/Miss


First Name:


Last Name:


Home Address:

Street Address:


City:


State/Province:


ZIP (Postal) Code:


Country:


Day Telephone Number:


Evening Telephone Number:


E-mail:


Fax: [optional]


Date of Birth: month day year            Male Female

Place of Birth (country, city):   

Citizenship (country):

Passport Number:


Nationality:


Your native language:




Education

1. Institution/college/university/graduate school:

Major:      Dates: GPA:


2. Institution/college/university/graduate school:

Major:      Dates: GPA:


3. Institution/college/university/graduate school:

Major:      Dates: GPA:


Languages studied & level of proficiency:






Other Information

Formal Training/Experience as a Teacher:

EFL/ESL:


Other:


Other Professional Training/Experience:


Current Occupation:


Any other relevant information, including where you hope to work after the course:


Are you a California resident? Yes No




Emergency Contact:


Name:


Relationship:


Telephone:


Address:






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? Month: Year:
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? Yes No
a. If no, on which Visa do you intend to enter the United States?
b. Please note that Non-immigrant alien students' documents (I-20) are provided for students taking a minimum of 20 lessons per week.

Accomodations.


 
Do you need accommodation? (please indicate) Yes No 
If yes, what type of accomodation would you prefer? (Please refer to Accommodation sheet.)
Homestay: Bed & Breakfast   PRIV  SH 
Homestay: Bed, Breakfast & Dinner   PRIV  SH 
Residence Club (Please specify which one and type of room/bath)
Hotel:
1st choice:
2nd choice:
3rd choice:
Do you smoke? Yes No 
Do you like pets? Yes No 
Do you like children? 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
(Cost is $60 to a private home or a Residence Club.)
**Arrival date:
**Time:
 **Flight Number:
**Without this information, airport pickup services can not be guaranteed.





Payment of Fees:

Please note that your application will be considered only when your payment of the non-refundable Application Fee of $75 and and the Tuition Deposit of $200 has been received.

The balance of fees is due no later than 15 days before the program starts.


Please note that you may apply online only if you pay by credit card.

If you are going to pay by a certified check, money order or by wire transfer, please click here to access a printable Application Form, print it out from your browser, complete it and send with your payment and Pre-Interview Task by post or by fax (if you make your payment by wire transfer).



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. All payments by credit card, except the payment of the application fee, subject to a 4.5-% credit card processing fee.

Please select payment option below:

Please charge the application fee and deposit only to my credit card provided below.

Please charge the application fee and the full payment to my credit card provided below.


To process your payment using Visa or MasterCard, please fill in the fields below with the requested information EXACTLY as it appears on your monthly bankcard statement.

Please select credit card:


Cardnumber:


Expiration Month:


Expiration 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:

Cardholder Name:


Street Address:


City:


State:


Zip Code:



Please double-check the above credit card information.





Autobiographical Essay.

Please write a brief essay. This essay must contain a short story of your life and experience, and reasons why you wish to study abroad.






Part E. 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 this site constitute part of my agreement with IPSA and study 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 have read the Agreement and agree to follow all IPSA and study program host procedures. I also understand that the School/IPSA reserves the right to reject any application without explanation; that acceptance of an application does not constitute the reservation of a place on a course. A place is only considered reserved once the Enrollment Agreement has been signed and returned to the School with the relevant payment; and that the Certificate course is very intensive and participants should be in a sufficiently good state of mental and physical health to be able to perform effectively during the course. 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.


Please click on the button to submit the Application: