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Registration form 2014

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IH New York - Adult Registration form 2014
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Page 1: Registration form 2014
Page 2: Registration form 2014

First Name

Male Female

Family Name

Nationality Native Language

Date of Birth (dd/mm/yy) Gender

Street Address

City Province/State

Postal Code Country

Home Phone Mobile Phone

Email

Emergency Contact Name

Emergency Contact Phone Number

Do you need medical insurance? Yes No, thanks (I have my own insurance)

Total course cost

Accommodation fees

Accommodation arrangement feeAirport transfer

Health insurance

Class Start Date (dd/mm/yy) Class End Date (dd/mm/yy)

Insurance Start Date (dd/mm/yy)

Note: Insurance fee - $6 for up to 30 days $2 per day

Insurance End Date (dd/mm/yy)

Start Date (dd/mm/yy) End Date (dd/mm/yy)

Arrival date (dd/mm/yy) Arrival time (hh:mm) Airline & Flight No.

Departure date (dd/mm/yy) Departure time (hh:mm) Airline & Flight No.

Do you require airport transfer? On Arrival: Yes No For Departure: Yes No

Website - whichFriend Search engine - which Facebook Agency Other

Note: !ere is a $100 non-refundable accommodation arrangement fee for all accommodation reservations.

If you do not have the details of your arrival at the time of registration, please provide us with this information as soon as you can. Note: We are not responsible for flight changes and last-minute cancellations.

� �

� Total cost due

Registration fee

Credit / Debit cardCard number Name on cardExp.

Card billing address

C V V#

All payments must be made in US dollars. All payment documents must include:[1] Full name of student, [2] Course start date.*No additional fees will be charged for bank transfers or credit card payments.

Intensive 20Silver Package (Int 20 + 5)Gold Package (Int 20 + 10)Platinum Package (Int 20 + 20)

Executive English 20Silver Pack (EE + 5)Gold Package (EE+10)Platinum Package

Total number of classes

Desired schedule for private classes - days and times (possible start times 9am, 11am, 1.30pm, 3.30pm)*

We'll do our best to meet your request, but no times guaranteed until confirmed.

TOEFL IntensiveFCE IntensiveCAE Intensive

Choose your housingSingle Shared ( bunk )

Single Shared ( bunk ) 1bed 2 beds

1bed 2 beds 1bed 2 beds

Shared - 4-6 bed dorms Shared - 8-12 bed dorms

Bed in basic dorm Private room shared bath Private room en-suite

(Outside Manha"an and above 96th St.) w/breakfast & shared bathroom private bathroom

dinner, shared bathroom

Materials fee

Other fee

���

Agent's signature or stamp

RecipientBank Swift CodeBank NameAccount NumberRouting Number/ABA

International House New York, Inc.Chasus33Chase Bank744033127021000021

101 Barclay StreetNew YorkNew York10007USA

AddressCityState/RegionZip/Postal CodeCountry

Bank Transfer

* ���

(Manhattan below 96th St.) w/breakfast

���

Page 3: Registration form 2014

The Executive English course plus 5 private one-to-one lessons per week.

!e Executive English course plus 10 private one-to-one lessons per week.

!e Executive English course plus 20 private one-to-one lessons per week.

Add a 75-minute lunch with a teacher at a locprogram – a great way to maximize the efficiency of your schedule and practice your English over a meal in an au

Program

Executive 20Executive Silver Package (EE + 5)Executive Gold Package (EE + 10)Executive Platinum Package (EE + 20)One-to-One Private classes

$640$$1,3 0$$8 /lesson (10% discount on

packs of 20 lessons or more) $150 per session – 12:45pm-2:00pm

Prices below are per week.1 week 2 weeks +

$580$9 5

$1,2 5$1,

6 students$ 0Every MondayIntermediate (B1)

Maximum students per group class Price of books and course materialsCourse start dates Minimum level

8 students20 lessons plus weekly private 1-lesson tutorial10 weeks

, 1, September 2FCE = Upper Intermed ate (B2)CAE = Advanced (C1)

Maximum students per classLessons per weekCourse lengthCourse start datesMinimum level

Intensive Cambridge ESOL exam preparation courses. !e FCE is for upper-intermediate level students, the CAE is for advanced-level students. Maximum 8 students per class, so everyone gains from personal a"ention.

Program

FCE, CAE IntensiveOne-to-OneExam fee

Price

$4,000$8 /lesson (10% discount on packs of 20 lessons or more)

$42 - please request exam registration form

Other exams also possible by arrangement - please contact us on @ihnewyork.com

14 students20 lessonsEvery MondayWeekly - Friday and Saturday$180**Intermediate (B1)

Maximum students per classLessons per week Course start dates Exam dates Exam fee*Minimum level

*Students register themselves for the exam at www.ets.org**Exam fee subject to change by ETS

Program

TOEFL Intensive $3 0 $3 0

Ensure that your course is completely focused on your own personal needs and you progress in the fastest time possible by studying a course of private lessons with one of our experienced teachers.

* Subject to availability of teacher trainer – please enquire if interested** Applies to any lessons finishing a#er 7.30pm. Weekend rate also applies to lessons on Federal Holidays.*** In Manha"an below 59th Street – other locations available by arrangement.Minimum lesson duration for o$-site classes is 2 lessons per visit.****All on-site private classes will be scheduled at 9am, 11am, 1:30pm or 3:30pm unless otherwise agreed in advance.

Program

Single classA package of 20+ lessons on a flexible schedulePedagogy classes with a teacher trainer*Weekend and evening supplement**Classes in your home or office*** – supplement per visi

price per lesson

$8$ . 0$$100

$$

A 20-lesson-per-week General English course.

The Intensive 20 course plus 5 private one-to-one lessons per week.

!e Intensive 20 course plus 10 private one-to-one lessons per week.

The Intensive 20 course plus 20 private one-to-one lessons per week.

Program

Intensive 20Silver Package (Int 20 + 5)Gold Package (Int 20 + 10)Platinum Package (Int 20 + 20)

One-to-One

1 week

$3 0$7 0

$1, 0

$1, 0

$8 /lesson(10% discount on packs of 20 lessons or more)

2-4 weeks

$3 0$7 0

$1, 0

$1, 0

$33$

$1,0

$1,

$31$6

$

$1,

Prices shown are per week5-10 weeks 11-15 weeks 16+ weeks

$29$

0

$1,

14 students$ 0Every Monday

Maximum students per group classPrice of books and course materialsCourse start dates

Business Lunch$

1 week 2-4 weeks weeks - weeks weeks

$3 $3 $

A 20-lesson-per-week program of Business English, focusing on English for specific professional needs.

Page 4: Registration form 2014

May 2July 4September November 2December 25

Memorial DayIndependence DayLabor DayThanksgivingChristmas

- Registration fee: $1 0- Materials fee: $ 0- Accommodation arrangment fee: $100

Airport Transfer Service: $1 each way- GlobalGuard student insurance coverage:

International House Language School New York is a member of the International House World Organization

Add a weekend of skiing or snowboarding in the Catskill mountains near New York this winter for just $299 per person.Price includes bus from Manhattan to Hunter ski resort early on Saturday morning, returning on Sunday evening. Bed and breakfast included in a shared double room.Li# pass, ski or snowboarding lessons and equipment rental are all payable at the resort (we’ll be there to help you organize this!) and will cost around $70-$100 per day depending on your skiing or snowboarding experience. Don’t even worry about the weather – Hunter has some of the best snow-making equipment available!

IH New York will be going skiing on January 1 -1 , January 2 -2 and February - .

Residences are centrally located and offer basic accommodation at competitive prices, mostly with shared bathroom and internet in the common areas. The Vanderbilt & West Side Residences are both busy, budget options with shared bathroom and include free gym & pool access in the building. Hotel 99 and the Broadway Residence offer budget accommodation in excellent locations, with both private and shared bathroom options available.

IH New York o$ers a selection of private apartments for students to rent on their own or share with friends or family. Prices vary from about $2,300/month to about $5,000/month. Apartments are located in Manha"an, Brooklyn and New Jersey. Contact us for details.

For students on a tighter budget, hostels offer clean, safe, shared-room accommodation. Often populated with a young traveling crowd, staying in a hostel can be fun, though it may be a little noisier than a homestay or residence.

Dec. 23 - 31: high season

Standard homestay with breakfast & shared bathroomExecutive homestay with breakfast & private bathroom

If you are looking to have a more authentic living experience in New York, you may want to stay in an English-speaking household. We

Homestay - Outside Manhattan & Manhattan abovw/ breakfast & shared bathroomw/ half board (breakfast & dinner) & shared bathroomw/breakfast & private bathroom

Vanderbilt Residence / West Side Residence (prices are per )Single room, shared bathroomShared room, 2 bunks (only for 2 people traveling together)

Central Park Inn (4 weeks minimum stay, prices per week)One-bed studio, private bathroomTwo-bed studio, private bathroom

$280$550$980

Broadway Hotel & Hostel (per week)Winter (Jan-Mar)Bed in basic dormPrivate room shared bathPrivate room en-suite

$380$900

$1,150

Summer (Apr-Dec%)Bed in basic dormPrivate room shared bathPrivate room en-suite

$Hostelling International New York (per week)Shared - 4-6 bed dorms $3Shared - 8-12 bed dorms

$5$

Hotel 99 (4 weeks minimum, prices per week)One bed, shared bathroom Two beds, shared bathroom $

One bed, private bathroom Two beds, private bathroom

For students who are interested in staying in a full-service hotel, there are numerous luxury accommodation options near the school in Chelsea and throughout the city's most fashionable neighborhoods.

Prices from $180-$350 + tax per night depending on the seasonContact us on [email protected] for details.

Hotel-quality accommodation for private club member prices. Excellent central locations, prices from $194-$400 per night

226 West 26th St, 9th Floor, New York, NY, 10001, USATel: +1 (212) 732 0288 | Fax: +1 (646) 219 7759Email: [email protected] | Skype: ihnewyork

ex

Homestay -

$

Page 5: Registration form 2014

IH New York - Enrollment Agreement 201Terms and Conditions

Signature

1. Payment of Fees(SS�Z[\KLU[Z�T\Z[�OH]L�WHPK�PU�M\SS�H[�SLHZ[����KH`Z�ILMVYLHYYP]HS��;\P[PVU��HJJVTTVKH[PVU�VY�HPYWVY[�[YHUZMLY�KL[HPSZ^PSS�UV[�IL�JVUMPYTLK�\U[PS�HSS�MLLZ�OH]L�ILLU�WHPK�PU�M\SS�

2. Insurance,]LY`�Z[\KLU[�T\Z[�OH]L�HWWYVWYPH[L�TLKPJHS�PUZ\YHUJL��0/5@�YLJVTTLUKZ�\ZPUN�.SVIHS�.\HYK�0UZ\YHUJL��^^^�N\HYK�TL��HUK�� ���#��%���#���$&#������ #�� ��� #�&!�% �����*$�����������*������������ #�� ���#�$%�*$���%&���%$�� %�(�$�����% �%������ ������&�#����$&#������&$%�!#�$��%�����"&�'����%���$&#�������#%�����%�� ���##�'����� Registration Fee and Accommodation Arrangement FeeThe $1�0 registration fee and the $100 accommodation arrangement fee are non-refundable.4. Cancellation and Refund Polic\

�����(SS�JHUJLSSH[PVU�YLX\LZ[Z�T\Z[�IL�YLJLP]LK�PU�^YP[PUN�4.2 For cancellation requests received before the first day of�class, orfor students who never attend their course (no show),�students willbe charged only the non-refundable registration and�accommodationarrangement fees, plus the fees related to any�services (such ascouriers or insurance) that have already been�provided by that date,the sum of which is not to exceed $500.�������%� ���$%&���%����*������������ #����$�� ����%���(�%����� �� ��%� ����������%� ���$���$��%� ����� #���� �� ��%� ����������%� ������#��&������ #��%� ��������# ��%�����#$%���*� �����$$��� �#��&��$�(�����!!�*�% �� &#$�$� ��� &#�(���$� #���$$������� #�� &#$�$�� ���#�%����� &#�(���$��$%&���%$�(� �%�#����%�%���#�� &#$��(�%����%�����#$%�� &#�(���$�(���������%�%����% ���#��&���V�����%&�%� �����$��)��!%�� #�%� $��#���%����% �%�����#$%�� &#�(���$������� #�� &#$�$�� ���#�%����� &#�(���$��$%&���%$�(� �%�#����%�%���#�� &#$����%�#�� &#�(���$��&%���� #�� #��%�%�������! ��%� ��%��#� &#$��(���������%�%����% ���!# �#�%����� &�%� ��%&�%� ���������� ��#��!�����%��� ���# !�!�������������"� �"�����������"����������#��!�� ������#��"���� ���"����������"�����!"�$����"���!"#���"��""���������!!�!��"�"���������!��#�"��� �"������� �� �"��� ��#��!�$�����������#��"��������$����%���!�!���������!��� !����� "����$����"�����"���!�����!���$�����$������������$������������� ��#��!�$�"���������%!���� �����"������"��$ �""��� ��#��� ��#�!"�����"������������#�"�� ��� ����"���!����K���"����������"��� ���!!�"��� ��#��������$�������%� ��#���"O��� !���� ������%�"��"������"������"������%���"�

5. AccommodationWeekly accommodation providers (this includes the Vanderbilt Residence, the West Side Residence, Hostelling International New York and The Broadway Hotel and Hostel)����>OLYL�JHUJLSSH[PVUZ�HYL�YLJLP]LK�PU�^YP[PUN�H[�SLHZ[����KH`Z�ILMVYL�[OL�HYYP]HS�KH[L��[OL�JVZ[�VM�HJJVTTVKH[PVU�^PSS�IL�YLM\UKLK�PU�M\SS��L_JLW[�H[�/VZ[LSSPUN�0U[LYUH[PVUHS��^OLYL�����VM�[OL�JVZ[�VM�HJJVTTVKH[PVU�^PSS�IL�^P[OOLSK�

Please read the following and sign beside:

1. ���!�������� ���������������������������������������������������including the Terms and Conditions and the Cancellation and Refund policy.

2. ���!����������� ��������������������������������������#�������������have sufficient funds to pay for all tuition costs, accommodation and all other personal expenses during the full period of my course at IHNY.

3. I authorize �� to take appropriate action in the��!���������#��������emergency and I understand that I am responsible for all medical bills incurred.

4. I certify that the information provided in this enrollment form is accurate andcomplete.

5. I certify that I have received the NYS Student Disclosure Pamphlet.

����-VY�JHUJLSSH[PVUZ�YLJLP]LK�PU�^YP[PUN�SLZZ�[OHU����KH`Z��ILMVYL�[OL�MPYZ[�KH`�VM�[OL�HJJVTTVKH[PVU�YLZLY]H[PVU�I\[��ILMVYL�[OL�HYYP]HS�KH[L��0/5@�^PSS�^P[OOVSK�H�JVZ[�LX\HS�[V�VUL��^LLR�VM�HJJVTTVKH[PVU��VY������VM�[V[HS�IVVRPUN�MLL�MVY��/VZ[LSSPUN�0U[LYUH[PVUHS������(M[LY�HYYP]HS��MV\Y�^LLRZ»�UV[PJL�PZ�YLX\PYLK�[V�JOHUNL�VY�JHUJLS�HJJVTTVKH[PVU��(U�HKTPUPZ[YH[P]L�MLL�VM������TH`�IL�HWWSPLK�[V�HU`�JOHUNLZ��

4VU[OS`� (JJVTTVKH[PVU� 7YV]PKLYZ� �[OPZ� PUJS\KLZ� /V[LS� ��*LU[YHS�7HYR� 0UU�HUK�HU`�V[OLY�HJJVTTVKH[PVU�WYV]PKLYZ�UV[�ZWLJPMPJHSS`�UHTLK�PU�[OPZ�KVJ\TLU[�

����� �� �!� $�"���!�� ��������� ��"�����������"��������$������"����� !"�"%�����"�!����&���"��#!"���� ����$������� �� ��"������� ��"����������������� ����������"���!�� �� ����$������% �"����� �������������������� ����"������ ��"���� �$�����"���������������������%�������� ���������&�"���� �$��� �����"��� ���������%������� ��#����������� ���������"���!� ����$������% �"������!!�"��������������� �����"������ ��"����� !"���&����"������������"���� �!� $�"�����#"������ ��"���� �$�����"�������!"���#���"������������� ����"�������������������������������������������������� �"� �� �$��������������� ����"�'!���"�����!� ��#� ���"����������� �����������������"����� ��������!" �"�$��������������%����������������"����&�������!�

6. General6.1 IHNY reserves the right to terminate without refund the classesand accommodation of any student whose conduct is clearlyinappropriate.����0/5@�THRLZ�L]LY`�WVZZPISL�LMMVY[�[V�LUZ\YL�[OL�ILZ[�KLHS�H]HPSHISL�MVY�V\Y�Z[\KLU[Z��/V^L]LY��PM�HU�HJJVTTVKH[PVU�WYV]PKLY�Z\IZLX\LU[S`�W\ISPZOLZ�H�KPZJV\U[LK�YH[L��0/5@�JHUUV[�IL�OLSK�YLZWVUZPISL�MVY�[OL�WYPJL�KPMMLYLUJL�

7. Approval to Use Photos & Printed Material�\��������������������#�������#���������������������������"������������������� ������� �����"�������#���� ����������������������������������� ��������������� � ��������������"������������������������������"�����"������������� ����#���������!����������� ���#���������������������������"������������������������#�������������� �������������������#� ��������"������������������������������� �

8. Loss / Damage��������������������������������������������������#������������������������� ������������������������������������������������ �������������� �����������!��� ������������ ��������!���������������!�������������������������������� ������������������������������������������������������

9. Force Majeure�������������������������!�������#����� ���������� ��������#����������������"������������������� ���#��� ������� ��������������� �������������������������!�������������� ������� ������������ ������������������������� ���������������������� ������� ����������

Signature of applicant Please type your name here and sign in pen on your first day in school.

;OPZ�PZ�H�SLNHSS`�IPUKPUN�PUZ[Y\TLU[�^OLU�ZPNULK�

Name in print:

Agent's Certificate Number:

Signature of school agent at IHNY

Date:

Date:


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