8/7/2019 Intrax International Institute Application Form
2011
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2011 ApplicationPersonal Information
Male FemaleCountry of Birth
Country of Citizenship
Family Nameas appears in your passport
Address in your Countrystreet
city state zip
Address in the U.S.A.
(if applicable)street city state zip
Telephonein the U.S.A.
Telephonein your country
Email
First and Middle Nameas appears in your passport
Date of Birthmonth day year
/ /
Application Agreement & Health Declaration
I understand that the ees or this program are payable in ull
beore the course start date and agree to pay them in accordance
with the application conditions. I certiy that I am able to provide
or all other expenses related to my stayin the USA. I authorize the
release o my records and transcripts to the sponsoring
organization, admission ofces, amily members and Intrax
International Institute. I I attend a program in the USA, I am
aware that I must have medicalinsurance or the duration o my stay
in the USA. In the event o a medical emergency, I authorize any
hospital or doctor to initiate treatment and release medical
inormation or diagnostic inormation or insurance purposes. I
releaseIntrax and its representatives rom any liability or such
measures taken on my behal. I hereby grant Intrax permission to use
my likeness in photograph(s)/video in any and all o its
publications and in any and all other media, whethernow known or
hereater existing, controlled by Intra x, in perpetuity, and or
other use by Intrax. I will make no monetary or other claim against
Intrax or the use o the intervie w and/or the photograph(s)/video.
I am 18 years o age orolder and am competent to contract in my own
name. I have read this release, and I ully understand the contents,
meaning, and impact o this release. My signature below certifes
that I have read, understood and agreed to my rightsand
responsibilities in this agreement, and that Intrax cancellation
and reund policies have been clearly explained to me. Upon my
signature and acceptance by Intrax, this agreement is legally
binding and I have received a signed copy.
Program & Schedule Details
Choose an Intrax Center:
San Francisco San Diego Chicago
Which Intrax program(s) are you enrolling in?
General English
TOEFL Preparation
Business English
Cambridge FCE Mar 21 Sep 12Cambridge CAE Mar 21 Sep 12
Professional Certicates:
Marketing & Advertising Jan 3 Apr 4 July 5 Oct 3
Business Management Feb 7 May 9 Aug 8 Nov 7
Career Management Mar 7 June 6 Sep 6 Dec 5
When would you like to study?
*Please see General Inormation or start date options.
Start Date # of weeks
Choose your schedule:
Standard Intensive Super Intensive
Special Packages:
Academic Excellence: 24 weeks 36 weeks 48 weeks
Additional programs (optional):Career Preparation Activity # of
weeks
*See programs dates or more scheduling inormation
Private lessons
Private Instruction Program (PIP) Card
What type of Visa will you be traveling on?
Tourist Visa B1/B2 Visa Waiver
Student Visa F-1 Other
J-1 F-1 Transfer. Please list name of
current school
month day year/ /
month day year
/ /
Signature Date
Signature of guardian (I applicant is under 18 years o age)
Date
Payment by credit card MasterCard VISA DiscoverCard Credit
card#
Name(as it appears on the card) Expiration date
Signature of cardholder CVV security code(3 or 4 digit code on
back of credit card)
month day year
/ /
Accomodations Additional Details
Emergency Contact Information:
Do you want to purchase Intrax insurance? Yes No
Coverage start date
Coverage end date
Would you like airport transportation?
Arrival Yes No Departure Yes No
I you already have your fight details, please write it here:
Arrival Date: Arrival Time:Airline Name and Flight #: Airport
:
I not, send nal fight details to Intrax no later than 7 days
prior to arrival.
Do you want Express Delivery of your acceptance packet? Yes
No
How did you hear about Intrax?
What type of accommodation would you like?Homestay Private
room
Residence Club Shared room
Residence Club name:
I do not need housing arranged through Intrax
For how long would you like housing?
Check-in Check-out
Do you smoke? Yes No
Are pets ok in the house? Yes No
If no, please list types of pets that are not ok:
Do you have any pre-existing medical conditions or health
concerns?
Yes (allergies, mental illness) No
If Yes, please list:
name relationship
telephone email
month day year
/ /
month day year
/ /month day year
/ /month day year
/ /
8/7/2019 Intrax International Institute Application Form
2011
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Intrax International Institute 2011 Fees and Tuition
English Programs Weeks of Enrollment (price per week)1 to 12 13
to 23 24+ weeks
General English / TOEFL / Business English / Cambridge $260 $235
$225
General English / TOEFL / Business English / Cambridge +
Intensive $320 $290 $275
General English / TOEFL / Business English / Cambridge + Super
Intensive $380 $345 $325
Professional Certicates* 1 Certicate(4 to 5 weeks) 2
Certicates(8 to 9 weeks) 3 Certicates(13 weeks)
Professional Certicate $1,400 $2,520 $3,570
Professional Certicate + Intensive$1,640 $3,000 $4,290
Professional Certicate + Super Intensive$1,880 $3,480 $5,010
Accommodation
Homestay$35 (adult price per night)
$38 (minor price per night)
Residence Club Fee Varies by Location & Selection
Accommodation Placement $200
Accommodation Cancellation $150
Career Preparation Activity
Career Preparation Activity (10 - 15 hours per week)$100 per
week (4-7 weeks)
$60 per week (8+ weeks)
Special Package
Academic Excellence
$7,495 (24 weeks)$10,495 (36 weeks)$11,995 (48 weeks)
Fees
General Application $100
Materials** $100
Airport Transfer one way $130
Insurance per Week $30
Express Delivery Fee $75
Private Instruction Program (PIP) Card $200
Private Lessons $60 per hour
Minor Fee (students under age 18) $200
Your Program Total
All Prices are in USD. Intrax reserves the right to changeprices
due to unforeseen cost increases and/or exchangerate
uctuations.
*Professional Certicates has 3 modules: Career Man-agement (4
weeks), Business Management (4 weeks) &Marketing &
Advertising (5 weeks)**Returning students must pay the materials
fee again.
Standard Schedule: MTH, 913:45Intensive Schedule: MTH,
915:30Super Intensive Schedule: MTH 915:30, F 913:45
Intrax Application Checklist
1) Send the following items:Completed and Signed
ApplicationFinancial Certication (F-1 students only)
Passport CopyApplication Fee ($100)Accommodation Placement Fee
$200 (i requested)
Express Delivery $75 (i requested)
2) Once we have received the above items we will send you:An
Intrax Acceptance letter (and I-20 Form, i required)
Intrax Center Welcome Information
Your information will be sent electronically via email or by
regular post.
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Method of Payment
Please indicate your name, center location and start date with
all payments.
By Mail: Payments can be made by check or money order in U.S.
Dollars,
payable to:
Intrax International Institute
600 California St., Fl 10,
San Francisco, CA 94108, USA
By Credit Card: Visa, DiscoverCard and MasterCard are
accepted.
By Wire Transfer: You may wire your payment directly from
your
bank to our bank.
Account Name:Intrax International Institute
Bank Name: Wells Fargo Bank
Address: 420 Montgomery St., San Francisco, CA 94104
ABA No.: 121000248
Account No: 9552696396
Swift Code: BIC WFBIUS6S
Course Start Dates
Intrax accepts new students each and every Monday for most
courses. A
mandatory placement test is administered every Monday, followed
by an
orientation and a tour of the center and the surrounding
neighborhood. The
students class will then begin on Tuesday. For Professional Cer
ticates and
special Focus Class start dates, please visit our website,
www.intraxinstitute.edu.
Program Admission Requirements
Intrax accepts students 16 years and older. Minors under 18
years old must
submit a completed application along with a signed Minor
Agreement Form
when applying for our programs. The following programs have
English level
requirements: Professional Certicates, Business English,
Cambridge FCE /
CAE, TOEFL. The Professional Certicates and Career Preparation
Activities
also have additional requirements.
Career Preparation Activity
The minimum age requirement for this program is 18 years old.
You will not
be allowed to enter the Career Preparation class until your
complete Ap-
plication has been received and reviewed. You will take a
placement test on
your rst day at Intrax. Students participating on this program
MUST place
into Level 6 or higher, and demonstrate sufcient speaking and
listening
skills. If you do not place into this level when you arrive, you
will need toreach this skill level before you can begin preparation
for the Career Prepa-
ration Activity.
Professional Certicates
Students applying for the Professional Certicates program will
take a
placement test on their rst day at Intrax. Students MUST be a
minimum of
18 years old, place into Level 7 or higher; and must demonstrate
sufcient
speaking/listening skills and motivation in order to begin the
class. If you
do not meet these requirements when you arrive, you will need to
enroll in
a program to improve your English skills before you can begin
the Profes-
sional Certicate program.
Certicates of Completion
Students who successfully complete their program will receive an
Intrax
Certicate of Completion. Those students who do not successfully
completetheir program will receive an Intrax Certicate of
Participation.
Student Visa (U.S.)
F-1 student visa applicants must apply for a minimum of 4 weeks
and sign
up for a schedule of at least 20 lessons per week. If you
require an I-20 Form
for your F-1 student visa, fax or mail to our Admission
Department nancial
certication showing that sufcient funds will be available for
both your
tuition and living expenses while studying at Intrax. Please
provide at least
one of the following forms of certication:
A current personal bank statement or letter from your bank.
A letter of support from your parents/sponsor stating that they
will be
responsible for your expenses during your stay, and a bank
statement
or letter verifying their nancial ability to meet your
expenses.
A letter guaranteeing nancial support from a sponsoring
organization.
A scholarship letter from your government.
The SEVIS I-20 Form can only be issued after you have submitted
your
nancial certication, signed application and General Application
fee. The
U.S. consular ofcer will also need your nancial documentation
when you
apply for an F-1 student visa, so we suggest that you make
sufcient copies
of all documentation for both Intrax and visa application
purposes. Tourist
and visa waiver applicants may NOT sign up for a schedule of
more than 18
hours per week.
Insurance
Medical Insurance is recommended for all students. F-1 student
visa
holders must have medical insurance (or sign a waiver). If you
wish to use
your own insurance, you must show proof of coverage upon
arrival. Intrax
insurance is U.S. $30 per week . In the event of an early
departure, unused
insurance will not be refunded.
Books and Academic Materials
Books and materials for each program and class will be provide
d. There
is a one-time materials fee of U.S. $100 per enrollment for clas
s materials.
The materials fee also covers items suc h as photocopies,
handouts, andcomputer software for classes. The fee is
non-refundable after the rst
day of class. Students are encourage d to bring a personal
laptop if enroll-
ing in the Professional Certicates or Career Preparation
Activity.
Payment of Fees
General Application and Accommodation Placement fees are due
with
your application. All tuition, services and materials fees must
be paid
prior to the start of your program.
Cancellation and Refund Policy
Buyers Right to Cancel
Prior to the rst day of instruction, you may cancel and receive
a 100%
refund of the amount paid for tuition and Materials Fees, minus
the
Application Fee, Placement Fees, and service fees. After the rst
day of
instruction, tuition for your rst 4 weeks is non- refundable. If
you wishto withdraw from your Intrax program early and rec eive a
partial refund,
you must stop before you have completed half (50%) of your
program.
If you have completed more than half (50%) of your program you
will
not receive a credit or refund. Refund amounts are calculated
using the
minimum unit of 1 week and the weekly tuition price based on the
number
of weeks you actually completed . The center will pay or credit
any refund
within 45 days from the date of notice. Refund s are always
returned to the
payer. Notice of cancellation or withdrawal must be made in writ
ing to the
Center Director.
Dismissal
Intrax reserves the right to dismiss any student whose conduct
is unsatis-
factory to the discretion of the Center Direc tor whose decision
is nal.
No tuition or fees will be refunded in such cases and any unpaid
fees are
due immediately.
Accommodation
Intrax offers accommodation in Residence C lubs and homestay.
Residence
Club prices vary by room, meal, and bath options. Availability
of residence
club placements may be limited depending upon the season. See
Intrax
website for Residence Club details.
Accommodation Cancellation
Accommodation Placement Fees are non-refundable. If you decide
to
cancel your accommodation 2 weeks (or less) prior to your
arrival, a $150
Cancellation Fee will be charged. To cancel or change your
accommoda-
tion after arrival, at least 4 weeks prior notice must be given,
otherwise
accommodation fees for 4 weeks will be charged. The
Accommodation
Placement Fee is charged each time a new accommodation booking
is
requested.
Visa Denial Provision
If your visa application is denied, or you are refused entry to
the U.S. you
will receive a 100% refund of the amount paid for tuition and
Materials
Fees, minus any Application Fees, Placement Fees, and service
fees, as
long as you notify Intrax in writing before your accommodation
move-in
date, or your scheduled start date, whichever comes rst.
Liability
Intrax and its staff and representatives will not be liable for
loss, damage,
or injury to persons or property, however caused, except where
liability is
expressly imposed beyond exclusion by statute. Intrax will not
be liable in
the event that services contracted become impossible to supply
by reason
of any cause outside of the control of Intrax. Any question or
problems
concerning Intrax that have not been satisfactorily answered or
resolved
by Intrax should be directed to:Accrediting C ouncil for
Continuing Education and Training
1722 N Street, NW
Washington, DC 20036
Students may also contact their local U.S. Consulate to resolve
disputes
or concerns regarding student visa issues.
General Information
