IPSA - International Partners for Study Abroad

Italian Language School in Rome, Italy.
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.

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

I Wish to Book Weeks

Please check the program of your choice:

Individual Program

I Wish to Book Number of hours per week


Intensive Italian Course

Intensive Plus Italian Course

Super Intensive "A" Italian Course

Super Intensive "B" Italian Course

PREPARATORY COURSE FOR CILS EXAM

Non-Intensive Italian Course

Italian for Seniors

Italian culture Seminar: Cinema

Italian culture Seminar: Literature

Italian culture Seminar: Art History

Italian Wine Testing

Italian Cooking. Professional Chef course Level 1

Italian Cooking. Professional Chef course Level 2

Italian Cooking. Professional Chef course Level 3

Professional Pastry Chef Course

Italian Cooking. Professional Pizza Making Course

Italian Cooking. Non-Professional Course (individual lessons):

       I Wish to Book   Individual Cooking lessons (3, 6, 9, 12, 15, etc.)




Comments:






Part C. Accomodations.

Do you need our help with accommodation placement? Yes. NO.

If yes, please check a type of Accommodation:

APARTMENT SHARED WITH OTHER STUDENTS - single room

APARTMENT SHARED WITH OTHER STUDENTS - double room

APARTMENT SHARED WITH Locals - single room

APARTMENT SHARED WITH Locals - double room

Hotel

Do you require airport pickup?   Yes   No


Arrival date:    Time:

Airline:    Flight Number:





Part D. Payment of Fees:

A non-refundable application fee of $100.00 and a tuition deposit of $200.00 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 Euros. 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 tuition deposit has been received.

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. 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 if required.

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 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 application fee and the deposit 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 $100.00 and the tuition deposit of $200.00 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 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 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 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 E. 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 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 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 Arizona, USA.

Yes, I agree. I don't agree


Please click on the button to submit the Application: