Study English in USA, Boston School of Modern Languages, ESL Courses in the United States of America

814 South Street
Boston, MA 02131
Tel: (617) 325-2760
Fax: (617) 325-2763
info@studyenglish.com


**Fields marked with an asterisk are required***
First Name*
Family Name*
Date of Birth*	Age: (mm / dd / yy)
Country of Birth*
Country of Nationality*
Sex*
Profession
Company
Years of English instruction?

Address *Please enter your home address*
Address

City *
State	Postal Code
Country
Telephone*
Cellular Phone
Fax
E-mail*


*Select the course you would like to register for*

Group Instruction (ESL/200)
Number of Weeks
Lessons per Day	(Lessons are 50 minutes)
Part Time: 1 to 5 Lessons per day Full Time: 6 Lessons per day * I-20 given to Full Time students only

Combination Course (ESL/250)
Number of Weeks
Group Lessons (per day)	(Lessons are 50 minutes)
Private Lessons (per day)	(Lessons are 50 minutes)
Group and Private lessons per day should add up to no more than 8

Private Instruction
Number of Weeks
Private Lessons (per day)	(Lessons are 50 minutes)

English + Golf
Number of Weeks
Private Lessons (per day)	(Lessons are 50 minutes)
Golf Lessons (per day)	(Lessons are 1 hour)
Private and Golf lessons per day should add up to no more than 8

Select your Starting Date
Note: If you are at an intermediate level or higher, you may start on any Monday.

I need I-20 Form for a Student Visa* Yes No I will be transfering from another school in the U.S.

After you complete your English course, are you planning to study in an American university?* Yes No


Airport Pick-up
Airport Drop-off
Coffee Break & Lunch at School
Tours & Trips


Housing Options
Do you require housing?*	Yes No

Apartment
Shared Student Apartment (21 years old and over)
Shared Room
Private Room
Private Student Apartment (21 years old and over)
Number of People
Number of Beds
Executive Apartment
Number of People
Number of Beds
Host Family
Host Family
Shared Room
Private Room

Additional comments or questions


Person or Company responsible for tuition
Name
Title
Company Name
Address

City
State	Postal Code
Country
Telephone
Fax
E-mail
Relationship

Local Contact Person (If applicable)
Name
Address

City
State
Telephone

US $125.00 Application Fee (non-refundable)
US $100 Tuition Deposit (non-refundable)
US $150 Housing Placement Fee if you have requested Homestay or Apartment (non-refundable)
Total US $375.00 Deposit

Refund  & Cancellation Policy 
-----------------------------------------------------------
The $225 (Application fee of $125.00 and Tuition Down-Payment of $100.00) and the $150 housing fee, if applicable, for student visa applicants are nonrefundable.

The $75 application fee for local residents is nonrefundable.
-----------------------------------------------------------
Cancellation before the start of class:

1. If an applicant has his/her visa application rejected, a full refund of all monies paid, less non-refundable charges will be made.  This refund will not be made until student returns I-20 form to BSE.

2. If BSE cancels a program or class subsequent to a student's enrollment, BSE will refund all monies paid by the student.

3. If a student cancels prior to the start of scheduled classes or never attends (no-show), BSE will refund all monies paid, less non -refundable charges (application fees, housing fees).
-----------------------------------------------------------
Withdrawal or Termination after the start of class:

1.  BSE is not obligated to make refunds to students who are terminated by the school due to violation of school policies, local, state or federal law.

2. Program 4 weeks or less.
BSE may retain all the tuition charges for the session.

3. Program Greater than 4 weeks.
For students who withdraw at any point during the first four weeks, BSE may retain the charges applicable to the first four weeks.  For students who withdraw after the first four weeks but before or at the mid-point of their program, BSE may retain a prorated amount of tuition.  For students who withdraw after the mid-point of their program, the institution may retain all of the charges for that program.

3a. Prorated refunds will be calculated on a weekly basis.  BSE will consider a partial week as if a whole week were completed, provided the student was present at least one day during the scheduled week.   
-----------------------------------------------------------
Refund Due Dates:

For a student who is a "no show or cancels prior to the start date, all refunds will be made within 30 days of the first scheduled day of class or the date of cancellation, whichever is earlier.

For an enrolled student, the refund will be calculated by the last date of attendance and be paid within 30 days from the date of determination.  The date of determination is the date documented by the student wishing to cancel.  The student must give written or verbal notice of withdrawal.  If BSE wishes to terminate the student due to the student's failure to follow school policies (attendance, conduct, etc), the refund will be issued within 30 days of the date of termination.
-----------------------------------------------------------
Policy for Changing Housing:

•	Students who wish to change their housing must file a Request for Housing Change form, available at the Information Desk.

•	Students may request a host family change at any time.  No reason is needed.  BSE will change the student’s host family at the earliest availability.  Students who change host families will be charged a $25.00 Relocation Fee for each change.

•	Students who change from a BSE student apartment into a BSE host family or into self-housing will be charged a $25.00 Relocation Fee.

•	Use of any BSE host families must be authorized and processed by BSE.  Payments for BSE host families must be made to BSE.  Students may not pay any BSE host families directly.

•	Students who use any BSE host family without authorization or who make payments directly to any BSE host family will be charged a $175.00 Housing Network Fee in addition to a $25.00 Relocation Fee.
-----------------------------------------------------------
Photography Release Form:

I hereby grant to Boston School of English the irrevocable and unrestricted right to use and publish photographs of me, or in which I may be included, for College publications, electronic reproductions (web sites) and/or promotional materials or any other purpose and in any manner or medium. In addition, I grant my permission to alter the same without restriction; and to copyright the same. I hereby release the photographer and BSE from all claims and liability relating to said photographs.
-----------------------------------------------------------
Acknowledgment:

I acknowledge acceptance of the terms and conditions of the refund policy as stated in this application. I understand that BSE is not financially responsible for me and/or my dependents, and that I need a minimum of $2500 plus $500 for every dependent per month to cover tuition, housing, and living expenses.   I also understand that I will not be allowed to re-register or transfer to another school if I have any outstanding financial obligation to BSE. I certify that the information provided in this application is true.


Payment must be made by either Bank Check US$ (written in English), Bank Transfer or Credit Card:
Check
Bank Transfer
Credit Card