IPSA - International Partners for Study Abroad

English Language School in Cairns, 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:






Part B. Program data.

Which course do you want to attend?

I want to attend a General English Full Time Program

I want to attend a General English Part Time Program

I want to attend English for Customer Service

I want to attend a 12-week Cambridge Exam Preparation Program

I want to attend IELTS Exam Preparation Program

I want to attend English plus Reef Safari Program (2, 3, or 4 weeks programs are available)

I want to attend English plus Tropical Safari Program (2, 3, or 4 weeks programs are available)

I want to attend a Private (One-To-One) Tuition Program with lessons a week

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 D. Accomodations.

Do you need help with accommodation? YES   NO

If yes, Which type of accommodation do you prefer?

Homestay
Hostel - self catering
Private room





Part C. Payment of Fees:

A non-refundable application fee of US$100 and a Tuition Deposit of US$200 are required with your application. The above fees and the deposit are part of the cost of your program and are deducted from the total of the program fees after conversion them in Australian dollars according to the current exchange rate for buyers communicated by IPSA on the invoice date. Please note that your application will be considered only when your payment of the application fee and the tuition deposit has been received.

Upon receiving your application and your payment of the required fee(s) and the tuition deposit, we will send you a registration confirmation and invoice for the balance due. The balance should be paid in Euros or in U.S. Dollars. 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.

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 the application fee by a certified check, money order or by wire transfer, please click here to access a Monospaced Printable Application Form, print it out from your browser, complete the form and send your application by fax or mail.


Payment by Credit Card

We accept only 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 the tuition deposit of $200.00 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 application 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 course. 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 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/Province:


Zip/Postal Code:



Please double-check the above credit card information.





Part D. 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 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 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 conditiones 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: