Day Telephone Number
Evening Telephone Number
Fax Number (optional)
Date of Birth (day-month-year)
Place of Birth (country, city):
I wish to book Weeks
I wish to start classes on: (Day) (Month) (Year)
I am applying for the following program at Arizona Language Institute in Phoenix:
Spanish or Foreign Language Group Courses:
Afternoon Spanish or Foreign Language Group Course (6 group lessons a week)
Evening Spanish or Foreign Language Group Course (6 group lessons a week)
Saturday Spanish or Foreign Language Group Course (6 group lessons a week)
Private Spanish or Foreign Language Classes
Private Spanish or Foreign Language Course with one-to-one lessons per week (12 lessons minimum)
Private Spanish or Foreign Language Classes Comments:
Please Select One of the Following:
I am applying for the Language Course for Adult Learners
I am applying for the Spanish/Foreign Language Survival Skills Course
I am applying for the Language Course for Children
Please Select the Language You Want To Study:
For how long have you studied English?
What is your present level of Spanish or Foreign Language you want to study?
Your Spanish or Foreign Language Learning Goals:
A non-refundable application fee of US$50.00 and the tuition deposit of $200.00 are required with your application. 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 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.
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 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 tuition deposit by credit card, check or international money order or by wire transfer to our bank account.
printable application form in PDF
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 US$50.00 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.
Please select credit card:
(Month) / (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:
Zip (Postal) Code
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 Arizona Language Institute and/or IPSA websites constitute part of my agreement with Arizona Language Institute and/or IPSA, 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 Arizona Language Institute and/or IPSA and all their officers, agents, independent contractors 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 programs and courses, excursions, and/or on and off-campus activities. I have read all terms and conditions and rules and agree to follow all Arizona Language Institute and/or IPSA procedures and regulations. This Agreement will be effective when my application is accepted by Arizona Language Institute and/or IPSA and shall be governed by the laws of the State of Arizona, USA.
Yes, I agree.
I don't agree