IPSA - International Partners for Study Abroad

English Language School in Queenstown, New Zealand.
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.

Where would you like to attend the course?

in Queenstown
in a Christchurch division of the School
in both locations

When would you like to start your course?

Day: Month: Year:

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

1 week
2 weeks
3 weeks
4 weeks
5 weeks
6 weeks
7 weeks
8 weeks
more than 8 weeks. Please enter the number of weeks

Which course do you want to attend?
  1. I want to attend General English Full-time Course

  2. I want to attend General English Part-time Morning Course

  3. I want to attend General English Part-time Afternoon Course

  4. I want to attend General English Part-time Evening Course

  5. I want to attend English course & Ski/Snowboard Program for 5 afternoons per week in Queenstown (1 - 12 weeks, June - September)

  6. I want to attend English course & Ski/Snowboard Program for 3 afternoons per week in Queenstown (1 - 12 weeks, June - September)

  7. I want to attend English course & Ski/Snowboard Program in Christchurch (1 - 12 weeks, June - September)

  8. I want to attend Study & Activity Program (1 - 12 weeks, January - March)

  9. I want to attend Study & Farm Experience Program





What is your present level of English?

Speaking / Listening: Beginner Intermediate Advanced

Reading / Writing: Beginner Intermediate Advanced


Have you taken one of these English Tests?

TOEFL. Date: Score:

TWE. Date: Score:

IELTS. Date:

IELTS. Scores: Reading Writing Listening Speaking Total:





Part C. Accomodations.

Do you want us to arrange accommodation for you? yes no
If yes, what form of accommodation?

Homestay
Student Apartment

If you choose hostfamily, please also answer the following questions:

Do you smoke? yes no

Will you live in a house with children? yes no

Will you live in a house with pets? yes no

Are there any foods you cannot eat? yes no

If yes, please provide details:


Will your husband, wife or other dependants join you in New Zealand? yes no

Number of adults    Number of children


Do you want us to meet you at the Airport when you arrive? yes no

Number of people arriving:

Airline and flight number:

Arrival date:    Arrival time:





Part D. Payment of Fees:

A non-refundable application fee of US$100.00 and a tuition deposit of US$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 New Zealand Dollars. 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 and required payments, we will send you an e-mail (or fax) confirmation and invoice within four to five business days. The confirmation will contain the details of your course and all pertinent costs. The invoice will be issued in New Zealand Dollars. You can make a payment in U.S. Dollars or in Euros 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. Once we receive your full payment, you will be sent a certificate of enrolment for visa purposes and your housing confirmation.

Please note that you may apply online only if you pay an 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 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. All payments by credit card, except the payment of the application fee, are subject to a 4.5-% credit card processing fee.

Please select payment option below:

Please charge the application fee of $100 and the tuition deposit of $200 to my credit card provided below.

Please charge the application and all other fees to my credit card provided below.


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 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: