IPSA - International Partners for Study Abroad

English Language School in Denver, Colorado, USA.
Online Secure Application Form.


Part A. Personal data:


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:


Other languages, if any:


I am currently: a college/university freshman sophomore junior senior
Graduate Student High School Senior Interested Adult Professional

If you are a graduate or undergraduate student, please provide the following information:

Current college/university/graduate school:

My major field of study:       GPA

If you are a professional, please specify your profession and company:

Profession:

Please enter the address of your college, university or company:






Insurance:

It is advisable that students have health insurance while residing or traveling in the United States. The insurance carrier in the student's home country can provide this coverage, or short term health coverage through an American company can be arranged. 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 for $78/month.

My insurance company is:


Policy Number:






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
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? Yes No





Part B. Program data.



I Wish to Start Classes on (Day) (Month) (Year)

(You can start classes on any Monday.)

How Many weeks do you plan to attend?     Please enter a number of weeks:

I want to register for the following program: (Please select a program below)

Exectutive Programs

Platinum Executive 1 Plus - Immersion plus "Live and Learn"
Platinum Executive 1 - Immersion
Gold Executive 2 - Group instruction + Private instruction
Silver Executive 3 - Group instruction (minimum enrolment: 4 weeks)
Executive Private Classes with lessons per week (12 lessons a week minimum)
"Live and Learn" program (10 hours a week)
I am interested in Family Package:

Executive program comments

Junior Winter Program

Junior Winter Program
   add Ski/Snowboard Intensive Package

Intensive English Programs for Students

Platinum Full Immersion Intensive English (minimum enrolment: 1 week)
Gold Intensive English (minimum enrolment: 2 weeks)
Silver mini-group Intensive course (minimum enrolment: 4 weeks)
Academic English Program (minimum enrolment: 1 term)
Student Private Classes with lessons per week (12 lessons a week minimum)

University Placement Service - Undergraduate
University Placement Service - Graduate

Test Preparation

Intensive GRE Preparation (12 weeks)
One-on-one GRE Preparation classes (12 hours package)
One-on-one GRE Preparation classes (36 hours package)

IELTS Preparation (4 weeks)
One-on-one IELTS Preparation classes (12 hours package)
One-on-one IELTS Preparation classes (36 hours package)

Tourist Program

Tourist Program with host family accommodations included
Tourist Program without accommodations

Elective Course Options

Please check the course options which are of most interest to you:


English for Business and Legal English:

Business Correspondence

Telephoning in English

Business Grammar

Management

Business Vocabulary

Making Presentations

Negotiating Skills in English

Marketing

Business Law

Introduction to Information Technology


English & American Studies:

Reading for Comprehension and Vocabulary

Writing Workshop

American Film Series: American Idioms, Listening and Vocabulary

Current Events and News Stories: Discussion & Debate

News for Now

English Grammar

University Preparation

Presentations and Public Speaking

Conversational English for Everyday Purposes


Are you interested in TOEFL/TOEIC preparation courses?

TOEFL

TOEIC

Program comments:

I have studied English for  Years at a 
(type of school e.g. high school, university, private language school, other)

What is your level of English?
    Zero Beginner
    Elementary
    Pre-Intermediate
    Intermediate
    Advanced


Accomodations.

Do you need accommodation?      Yes      No 

If yes, what type of accomodation would you prefer?

Apart-Hotel (Homestead Village)

Hotel (Four Points Sheraton)

Host Family

Apartment (for students studying more than 3 months)

Please enter below your accommodation requirements (if any):



Do you require airport pickup?     Yes.     No.

**Arrival date:      **Time:

**Airline and Flight Number:

**Without this information, airport pickup services can not be guaranteed. Students opting for Host Family lodging will be picked up and delivered to the airport by their host family provided they arrive or depart on a weekend.

Car Rental

The School offers a limited number of cars for rental to executive students. Please indicate if you would like to rent a car: Yes.     No.
From: (Day) (Month) (Year)
To:     (Day) (Month) (Year)





Part C. Payment of Fees:

Please note that your application will be considered only when your payment of the non-refundable application fee of $155 and a tuition deposit of $350 has been received. The Tuition Deposit is part of the cost of your course and is deducted from the total tuition fees.

Please note that you may apply online only if you pay the application fee and deposit 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 monospaced Application Form, print it out from your browser and send it with your payment 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.

Please select payment option below:

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

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

Even if you select a "full payment" option, we will charge the application fee(s) 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 "full payment" option), a 4.5% convenience payment processing service fee will be included in the invoice. There is no any additional charge when you pay the application fee and the tuition deposit by credit card.
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.





Part D. 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 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 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 Florida, USA.

Yes, I agree. I don't agree


Please click on the button to submit the Application: