IPSA - International Partners for Study Abroad

English Language School in Byron Bay, Australia.
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:






Emergency Contact:


Name:


Relationship:


Telephone:


Address:






Visa Information:

I already have a visitor(tourist) visa
I already have a working holiday visa
I will apply for a visitor(tourist) visa
I will apply for a working holiday visa
I will apply for a student visa
Other

If you selected "Other", please provide the details:






Part B. Program data.

Which course do you want to attend?

I want to attend a full-time course of English for General Purposes

I want to attend a part-time course of English for General Purposes

I want to take Private Classes. I want to take Private Classes per week.

I want to attend Cambridge First Certificate 12-week course

I want to attend Cambridge First Certificate 10-week course

I want to attend English and Surfing Classes (5 surf classes per week)

I want to attend English and Surfing Classes (3 surf classes per week)

I want to attend English and Diving Classes

I want to attend English and Music Classes

I want to attend English plus Activities Classes

When would you like to start your course?

Day: Month: Year:

For how many weeks do you want to attend the course?:

2 weeks (min)
3 weeks
4 weeks
5 weeks
6 weeks
7 weeks
8 weeks
more than 8 weeks. Please enter the number of weeks

What is your present level of English?

Beginner
Intermediate
Advanced






Part C. Accomodations.

Do you need help with accommodation? YES   NO

If yes, Which type of accommodation do you prefer?

Homestay
Hostel - self catering
Private room


If you request homestay accommodation, please answer the following questions:



Are you a smoker ? yes no

Do you mind if someone smokes in your host family? yes no

Would you prefer a Family with young children? yes no

Older children? yes no

No children? yes no

Do you drink alcohol? yes no

Are you married or single? married single

What are your favorite interests or hobbies?
If you have a special diet, please specify:
If you have allergies, please specify:
If you have other requirements, please specify:





Airport pick-up

Do you require airport pickup?     Yes.     No.

If yes, please select one of the following options and provide us with your flight arrival information (you can also request the airport transfer at the time of submitting the application and send your flight arrival information at a later date)

Meeting and transfer from Brisbane airport (Au$195)
Meeting and transfer from Ballina airport (Au$80)
Meeting and transfer from Coolangatta airport (Au$110)

**Arrival date:      **Time:

**Airline and Flight Number:

**Without this information, airport pickup services can not be guaranteed





Part D. Payment of Fees:

A non-refundable application fee of US $100.00, and a tuition deposit of US $200 are required with your application. The tuition deposit is part of the cost of your course and is deducted from the total tuition fees after conversion in Australian Dollars. 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 the tuition deposit, we will send you a registration confirmation and invoice.

The invoice will be issued in Australian Dollars. You can make a payment in Euro or in U.S. Dollars according to the current exchange rates. 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 enrollment fees and the tuition deposit by credit card.

You can also print out a a monospaced printable application form 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.

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 $100.00 and a tuition deposit of $200 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 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 fees and the tuition deposit by credit card.

Please select credit card: Visa MasterCard

Cardnumber:


Expiration Date:
(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:

Cardholder Name:


Street Address:


City:


State:


Zip (Postal) Code



Please double-check the above credit card information.





Part E. Autobiographical Essay (optional).

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 F. 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 Arizona, USA.

Yes, I agree. I don't agree


Please click on the button to submit the Application: