Learn Spanish and Foreign Languages in WPB!

Palm Beach Language Institute is the best place to learn Spanish and Foreign Languages 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!

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:
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:  
Italian, French, German, Portuguese and Spanish Group Courses: Afternoon 4-week Italian, French, German, Portuguese or Spanish Group Course (24 group lessons)
Evening 4-week Italian, French, German, Portuguese or Spanish Group Course (24 group lessons)
Private Spanish or Foreign Language Classes: Private Spanish or Foreign Language Course with 12 one-to-one lessons

Private Spanish or Foreign Language Course with 24 one-to-one lessons

Private Spanish or Foreign Language course with one-to-one lessons (if more than 24 lessons)

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: Spanish
Arabic
Chinese
Farsi
French
German
Hebrew
Hindi
Hungarian
Italian
Korean
Polish
Portuguese
Romanian
Russian
Serbian
Tagalog
Ukrainian
What is your present level of Spanish or Foreign Language you want to study? Complete Beginner
High Beginner
Lower Intermediate
Intermediate
Pre-Advanced
Advanced
For how long have you studied Spanish or Foreign Language?
Your Learning Goals:

Payment information:
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. 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$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.

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 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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