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Application Form/English *Required Field Please type or print legibly PART 1. Applicant Information Applicant Name*: _____________________________________________________________________________________________________________________________________________________________ Last Name,First NameMiddle InitialTitle (if applicable)Sex*: ? Male ? FemaleDate of Birth*: M_________/D________/Y___________ Country of Birth*: ______________________________ Native Language*: _________________________________Preferred communication: ?Email ?Telephone Email Address*: _________________________________________@___________________________U.S. Address*: ____________________________________________________________________________ U.S. Telephone Number*: ___________________________________ ___________________________________________________________________________________________________________________________________________________________________________CityState Zip CodeForeign Address: ____________________________________________________________________ Foreign Telephone Number: ______________________________________ (if applicable)Address _____________________________________________________________________________________________________________________________________________________ CityState/Province/Territory Postal Code Country How did you hear about us? ? A Friend ? Google Search ? Facebook/Instagram ? Other: ___________________________Why do you want to study English? ? Academic Reasons ? General English Skills ? Other: _____________________________________________________I am interested in: ? TOEFL ? IELTS ? GRE ? GMAT ? None of these ? Other: ____________________________________________________________What area/s are you most interested in improving? Number them from 1 (most important) to 6 (least important): ________Speaking______Listening________ Writing________ Reading _______Grammar ______VocabularyPART 2 A: Program InformationStart Date*: ________/ ________/__________End Date*: _________/_______/__________ Month Day Year Month Day YearChoose Course(s):? Full-Time (1 quarter): Full tuition $3235.00 ? Full-Time $ 1125.00 /4 weeks ? Speaking & Listening $340.00 /4 weeks ? Vocabulary & Reading $230.00 /4 weeks ? Grammar & Writing $ 560.00 /4 weeks ? Full-Time $ 1125.00 /4 weeks ? Test Preparation $230.00/ 4 weeks ? $25.00 Placement Test? $50.00 Registration per class = $________________ ? Book $_____________ ? Evening English 8-Week Program $340.00 /24 hrs. ? Beginner ?Intermediate ? Advanced ?$50.00 Registration ? Saturday English 8-Week Program $340.00/24hrs. ? Beginner ?Intermediate ? Advanced ? $50.00 Registration ? Another package or Private Tutorial: _______________________________________________ Tuition $________________. _______ ? Total $____________________________. __________ PART 3 Terms and ConditionsFor admission into Tampa Language Center, students must complete the school application and depending on their citizenship and visa status, may be required to provide a copy of a valid passport or other form of picture I.D. We reserve the right to deny any service or documents to students with a financial obligation or legal process. Program Calendar, Schedule and PricingScheduling is based on the current Tampa Language Center program schedule. Minor deviations from the published schedule may take place but will not affect the total number of classes. Pricing is based on the current Tampa Language Center price list and prices are subject to change. You should not sign this Application for Admission before reviewing the official program calendar, schedule and price list. Private Classes only shall be entitled to 1 absence with credit per month if you notify 24 hours in advance via email or by calling the office. Refund Policy for Full-Time Students Who Pay in AdvanceIf Withdrawal or Cancellation occurs: The School Will Refund During 1st Week 80% of TOTAL tuition (we will return $2588.00)During 2nd Week 60% of TOTAL tuition (we will return $1941.00) After 2nd week 0% of TOTAL tuition Refund Policy for All Part-Time Students in Intensive English ProgramAll students may submit a written request to cancel three (3) days prior to the course start date and they will receive a full refund. During the period from 2 days prior to the class starting date until your third class, if you choose to withdraw from your course, you will only have a 70% tuition refund. After you attend your 3rd class, you will not qualify for a refund. This policy is only valid in your first month of studies. If you sign up for fewer than 4 weeks of classes, there will be NO refunds. Refunds will only be made to the person, company or agency that paid our school. If the student paid through an agency, he or she must speak directly with that agency for a refund, all refunds paid via check or wire transfer will be made via a refund check form the school. However, if school fees were paid by credit card, then the school will process the refund to the credit card used for payment. REFUND POLICY FOR 8 WEEK AND PRIVATE PROGRAMSAll students may submit a written request to cancel three (3) days prior to the course start date and they will receive a full refund. After this time, there will be no refunds made on tuition paid. Private Classes only shall be entitled to 1 absence with credit per month if you notify 24 hours in advance via email or by calling the office. PT Student Initials: ___________School Activities and Events Tampa Language Center hosts school activities both in school and in the community for all students. This may require transportation to and from such outings. Teachers are there to guide and coordinate and will not be held responsible for your well-being and/or your belongings. If you chose to participate in a school-related event, you agree and recognize that you are a willing participant in such events, and Tampa Language Center will not be held liable or responsible for any incidents or injuries that may occur.?By checking this box, I acknowledge that I have read, understood, and I accept all the Terms and Conditions above.___________________________________ ____________________(Electronic)Signature of Applicant or Guardian Date________________________________________________ ______/______/______ PRINT NAME DATE OF BIRTH Extended package: Start Date*: ________/ ________/__________ End Date*: _________/_______/__________ Month Day Year Month Day Year _________________________________________________ _______________________ Signature Date This extension will follow the same policies and rules from the original application signed on _________________________.Extended package: Start Date*: ________/ ________/__________ End Date*: _________/_______/__________ Month Day Year Month Day Year _________________________________________________ _______________________ Signature Date This extension will follow the same policies and rules from the original application signed on _________________________.Extended package: Start Date*: ________/ ________/__________ End Date*: _________/_______/__________ Month Day Year Month Day Year _________________________________________________ _______________________ Signature Date This extension will follow the same policies and rules from the original application signed on _________________________. ................
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