IPSA - International Partners for Study Abroad

Summer Camp in Spain.

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:


Do you need a student visa to study in Spain? yes no


Nationality:


Your native language:






Emergency Contact:


Name:


Relationship:


Telephone:


Address:






Part B. Program data.

Which program would you like to join?

Residential (with accommodation in our residences)

Day Camp (without accommodation)

Mornings (Language course only, without accommodation)

Home Stay (accommodation in our host families, only in Granada, Madrid, Salamana and Valencia, for students over 14)

Options for home stay or residential programs:

Single Room

Double Room


At which CAMP would you like to study?
When would you like to start your course: (MM-DD-YY)

For how many weeks you want to register: Total Number of weeks:
What is your present level of Spanish?



Comments:





Part C. Optional Sports.

Please select optional sports that you prefer to join:

1st  fortnight
2nd  fortnight
3rd  fortnight
4th  fortnight
If you have other requirements, please specify:





Part D. Airport Transfer and Bus Service.

Do you require airport pickup?

Yes    No

Arrival date:


Arrival time:


Airline:


Flight Number:

Do you require bus service to Summer Camp?

Yes    No
Arrival date:
Bus service options:

Part E. Payment of Fees:

Please note that your application will be considered only when your payment of the non-refundable Application Fee and Tuition Deposit (or a full payment) has been received.

Please also note that we must receive a full payment of tuition and accommodation fees (a balance due) at least 30 days before the commencement of your program.
.


Please note that you may apply online only if you pay an application fee by credit card.

If you are going to pay an application fee and deposit by check, money order or by wire transfer, please print out a monospaced Application Form from your browser, complete it and send 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 and deposit, are subject to a 4.5-% credit card processing fee.

Please select payment option below:

Please charge only application fee(s) and deposit to my credit card provided in this application.

Please charge application fee and full payment to my credit card provided in this application.


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 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 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: