I am applying for the following program in Boston, Massachusetts:
Standard ESL Group Program
Intensive ESL Group Program
Intensive ESL Plus Program
Private course number of lessons per week
Evening Part-time English Program
Saturday Part-time English Program
TOEFL Preparation Program
Full-time TEFL Certification Program
Part-time TEFL Certification Program
Group Business English Program
Group plus Private Business English Program
Private Business English Program
Private Professionals and Executives Program
Group plus Private Professionals and Executives Program
I wish to book Weeks
I wish to start classes on (Day)
What is student's present level of English?
For how long has the student studied English?
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).
Do you require accommodation?
If yes, please select one of the following options:
Host Family, single room, breakfast & dinner
Exclusive Residence - single room
Exclusive Residence - shared room
Student Residence - single room
Student Residence - shared room
Do you want us to arrange airport pickup?
Please supply flight arrival and departure information:
Please note: you can send us the flight arrival information at a later date after submitting this application.
Arrival Time: (24 hour clock)
Arrival Location: (airport)
Airline and flight number:
A non-refundable application fee of US$100 and a course registration fee ($140 - for international students or $50 - for domestic students), and a Tuition Deposit of $300 are required with the application (domestic students applying for part-time courses do not need to pay the tuition deposit).
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 application fee and the program deposit has been received.
If you have requested accommodations, please also send a non-refundable accommodation placement fee of $100 and a housing security deposit of $200.
Upon receiving your application, the application fee and the tuition deposit, we will send you a registration confirmation and invoice.
The payment of the balance of fees is due upon receipt of invoice. Student's place will be confirmed only when the full payment has been received.
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 registration fee and deposits by credit card, check or international money order or by wire transfer to our bank account.
a printable monospaced 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 a non-refundable application fee of US$100 and a course registration fee of $140 and a Tuition Deposit of $300 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.
(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