Learn English in West Palm Peach!

Palm Beach Language Institute is the best place to learn English as a Second Language because it is student-focused, enjoyable and affordable. Apply Now!

Online Secure Application Form

Online Secure Application to Palm Beach Language Institute.

Thank you very much for your interest in Palm Beach Language Institute in Florida!

Please complete the application form below and send it to our office. We will send you a confirmation no later than 24 hours after we receive your application.

Please note that you may apply online only if you pay the application fee and the program deposit online by credit card. We accept VISA and MasterCard. In our Online Secure 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.

Privacy Policy. We will never sell, rent, or give your personal information to any person or organization outside of our school.

Application Form

Personal and Contact Information
Mr/Mrs/Ms/Miss
Your Family Name:
Your Given Name (s):
Day Telephone Number:
Evening Telephone Number:
E-mail:
Fax: [optional]
Home Street Address:
City:
State (Province):
ZIP (Postal) Code:
Country:
Gender: Male    Female
Date of Birth (day-month-year):
Place of Birth (country, city):
Your native language:
Other languages:
Citizenship (country):
Passport Number:
Status and Visa Information
Are you NOW in the United States? Yes     No
a. If your answer is yes, when did you come to the United States? Month: Year:
b. What type of visa do you hold?
If you are not in the United States at this moment, on which Visa do you intend to enter the United States?
Emergency Contact:
Name:
Relationship:
Telephone:
Address:
Program Information:
I wish to book Weeks
I wish to start classes on: (Day) (Month) (Year)
I am applying for the following program:  
Intensive English ESL Courses: Intensive General English course (20 group lessons a week)
Intensive Plus General English course (28 group lessons a week)
Summer English Courses for Children and the Whole Family (July 2 - August 13, 2017): Summer English course for Children
Summer English course for Adults
Part-Time General English ESL Group Courses: Afternoon Course (6 group lessons a week)
Evening Course (6 group lessons a week)
Saturday Course (6 group lessons a week)
U.S. Citizenship Test Preparation Program: Evening Course (6 group lessons a week)
Saturday Course (6 group lessons a week)
Private General English Classes: Private General English ESL Course with one-to-one lessons per week (10 lessons minimum)

Private General English ESL Classes Comments:

American English Pronunciation & Accent Reduction: American English Pronunciation & Accent Reduction program in the classroom (10 lessons minimum)

Online American English Pronunciation & Accent Reduction program (20 lessons minimum)

I want to book American English Pronunciation & Accent Reduction program with the total number of one-to-one lessons
Test Preparation Courses: TOEFL
TOEIC
IELTS

Intensive TOEFL Preparation Mini-group Course with 20 lessons a week (3 to 6 students). Course duration: 4 weeks. If there are two students in the class, the number of lessons is reduced to 15 semi-private two-to-one lessons a week (60 lessons total, classes meet 5 times a week Monday through Friday from 1:00 pm to 3:15 pm (3 lessons a day). If there is only one student in the class, the number of lessons is reduced to 10 one-to-one lessons a week in the afternoon (40 lessons total).

I want to book the selected Test Preparation Private course with 20 one-to-one lessons with flexible schedule

I want to book the selected Test Preparation course with the total number of one-to-one lessons (more than 20 one-to-one lessons)

Comments:

English Courses for Executives and Professionals (including English for Law): Mini-Group Course for Executives and Professionals with 20 lessons a week.

I also want to book additional 5 one-to-one lessons per week (Executive Plus)
I also want to book additional 10 one-to-one lessons per week (Executive Plus)

Private English Course for Executives and Professionals with 15 one-to-one lessons per week
Private English Course for Executives and Professionals with 20 one-to-one lessons per week
Private English Course for Executives and Professionals with 25 one-to-one lessons per week
Private English Course for Executives and Professionals with 30 one-to-one lessons per week

All English courses for Executives and Professionals are tailor-made and include development of your general English language skills, remedial work on pronunciation and accent reduction and vocabulary building and writing skills, specific to your profession, as well as English for Specific purposes: telephone skills, meetings, presentations, etc. Upon registration we will send you the Executive Course Needs Analysis that will help us assess your requirements and formulate a unique program tailored to your needs.

Please select your program specialization:

Business English for Executives
General Executive English tailored to my specific learning needs
English for Law (Legal English)

English for Accounting & Finance
English for Automobile Industry
English for Aviation
English for Customer Care
English for Energy Industry
English for Human Resources
English for Law Enforcement
English for Logistics
English for Marketing & Advertising
English for Military
English for Pharmaceutical Industry
English for Sales & Purchasing
English for Telecoms and IT

English for Meetings
English for Negotiating
English for Presentations
English for Socializing

Executive English Course Comments. Please enter any comments below regarding your learning goals.



English Outside The Classroom: I also want to book hours of "English Outside The Classroom" (min. 10 hours)

This program can be booked only in addition to any of our group and/or private courses.

What is your present level of English? Complete Beginner
High Beginner
Lower Intermediate
Intermediate
Pre-Advanced
Advanced
For how long have you studied English?
Your English Learning Goals:

Accommodations:
Do you want us to arrange Hotel Accommodations for you? Yes.  No.
If yes, please select one of the following options: The Residence Inn Marriott - West Palm Beach Downtown - studio
The Breakers Palm Beach - Deluxe King
The Breakers Palm Beach - Premium King:

All accommodations are subject to availabilty.
Accommodation arrival date:
Accommodation departure date:
Supplementary Information: Do you smoke? Yes.  No.

Do you have any allergies? Yes.  No.

Please give details of any special requirements relating to accommodations:



Airport transfer:
Do you want us to arrange airport transfer for you? Yes.  No.

If yes, please select one of the following options: Arrival only.  Arrival and departure.
Please supply flight arrival information: Arrival Date: (Day) (Month) (Year)

Arrival Time: (24 hour clock)

Airline and flight number:


Arrival Airport:  PBI (WPB)   FLL   MIA (Miami)

Please supply flight departure information: Departure Date: (Day) (Month) (Year)

Departure Time: (24 hour clock)

Airline and flight number:


Departure Airport:  PBI (WPB)   FLL   MIA (Miami)

Payment information:
A non-refundable application fee of US$100.00 ($50.00 if you apply for Part-time ESL course) 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.

If you request hotel accommodations, a housing placement fee of $50 and a one-night deposit are also required with your application.

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 before the beginning of your classes (no later than 30 days before the beginning of the Intensive General English and Test Preparation courses and English courses for Executives and no later than 60 days before the beginning of the Summer Program for Children and the Whole family. Your place will be confirmed only when the full payment has been received. The full payment must be paid before we can issue documentation in support of a visa application if required.

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. 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.

You can also print out a printable application form 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.

Payment by Credit Card Please charge the application fee of US$100.00 ($50.00 if you apply for Part-time ESL course) and the tuition deposit of $200.00 to my credit card provided below. Please also charge the housing placement fee of $50 and a one-night deposit if I requested hotel accommodations

Please charge the application fee and the full payment to my credit card provided below.

Even if you select a "full payment" option, we will charge only the application fee and the tuition deposit at the time of accepting your application and will process the payment of the balance to your credit card after registering you for the program. Please also note that if you would prefer to pay the balance by credit card, a 4.5% convenience payment processing service fee will be included in the invoice. There are no any additional charges on your payment of the application fee and the tuition deposit by credit card.
Please select credit card: Visa    MasterCard
Card number:
Expiration Date: (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: Cardholder Name:


Street Address:


City:


State:


Zip (Postal) Code


Comments:

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 IPSA and/or Palm Beach Language Institute website constitute part of my agreement with Palm Beach 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 Palm Beach 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 Palm Beach Language Institute and/or IPSA procedures and regulations. This Agreement will be effective when my application is accepted by Palm Beach Language Institute and/or IPSA and shall be governed by the laws of the State of Florida, USA.

Yes, I agree.     I don't agree


Memebership & Affiliations

American "The American Council on the Teaching of Foreign Languages (ACTFL) is the only national organization dedicated to the improvement and expansion of the teaching and learning of all languages at all levels of instruction. ACTFL is an individual membership organization of more than 9,000 foreign language educators and administrators from elementary through graduate education, as well as government and industry."


International Partners for Study Abroad

International Palm Beach Language Institute is affiliated with IPSA Consortium of Language Schools and Study Abroad Programs - International Partners for Study Abroad. IPSA Consortium promotes the international education and offers language immersion and study abroad programs in 32 foreign language speaking countries. Over 90 public and private universities, colleges and language schools from all over the world participate in the IPSA Consortium.

 
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