IPSA - International Partners for Study Abroad

Language School in Lausanne, Switzerland.
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 student: freshman sophomore junior senior

Graduate Student High (Secondary) School Student Professional

If you are a high (secondary) school student, please provide the following information:

Name(s) and year(s) of last schools attended (and certificate(s) if any:



If you are a graduate or undergraduate college/university 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 school, college, university or company:






Insurance:

The Swiss law (1st January 1996) concerning sickness and accident insurance, demands that all students, residing in Switzerland, be insured against sickness and accidents by a recognized Insurance Company. The School provides accident insurance for all students, but you also need a health insurance.

We would therefore be grateful if, upon your arrival at the School, you could provide us with a statement from your Insurance Company, certifying that you are also covered in Switzerland. (Hospital - Doctor - Pharmacy)

If this is not the case, we have to insure you at the School for the period of your stay.

Please check on of the following:

My health insurance is valid in Switzerland

I would like to be insured by the The School against illness





Parents/guardian (if applicant is under 18 years old):


Father's/Gardian's Name:


Father's/Gardian's Address:


Father's/Gardian's Profession:


Father's/Gardian's Telephone numbers (work and home):


Father's/Gardian's Fax Number:


Mother's Name:


Mother's Address:


Mother's Profession:


Mother's Telephone numbers (work and home):


Mother's Fax number:






Reports to be sent to:

parents   student   gardian





Bills to be sent to:

parents   student   gardian





Emergency Contact:


Name:


Relationship:


Telephone:


Address:






Part B. Program data.

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

Please check the program of your choice:

1. Summer Courses

Summer course in Lausanne - 15 hours/week

Summer course in Lausanne - 20 hours/week

Summer course in Lausanne - IELTS - 20 hours/week

I Wish to Book:
    Number of weeks:

Please select the language for the summer course:
    French Summer course

    English Summer course

2. Year-round Language courses.

French (French plus English)

French Intensive Language Program: 25 periods of instruction per week

French Intensive Language Program: 35 periods of instruction per week

French Intensive Language Program (25 periods per week) Plus 10 periods of English per week

I Wish to Book:
    Number of weeks:



English (English plus French - non offered in summer)

English Intensive Language Program: 25 periods of instruction per week

English Intensive Language Program: 35 periods of instruction per week

English Intensive Language Program (25 periods per week) Plus 10 periods of French per week

I Wish to Book:
    Number of weeks:
Comments:






Part C. Accomodations.

I would like the School to organize accommodations: Yes     No

If yes, Please check a type of Accommodation:

Boarding House

If you have checked a Boarding School option, please select: Single Room   Double Room

Standard Room
Comfort Room
Comfort Plus Room

Comments:






Part D. Activities and Lunches for Non-Boarding Students.

Do you wish to participate in activities and excursions? Yes     No

Do you wish to have lunches at the School? Yes     No






Part E. Payment of Fees:

Please note that your application will be considered only when your payment of the non-refundable Application Fee of $150 and the tuition deposit of $250 has been received. The Tuition Deposit is part of the cost of your course and is deducted from the total program fees.

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

If you are going to pay by a certified check, money order or by wire transfer, please print out a monospaced Application Form from your browser, complete it and send with your payment by mail or by fax (if you make your payment by wire transfer or credit card).


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 the tuition deposit, are subject to a 4.5-% payment processing service fee.

Please select payment option below:

Please charge only the application fee(s) an the tuition deposit to my credit card provided below.

Please charge the application fee and the full payment 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 F. 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 G. 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: