Italian Language Application Form 2016

Italian Language
Application Form 2016
APPLICATION INSTRUCTIONS
RETURN COMPLETED FORM TO
Istituto Lorenzo de’ Medici – Italian Language Enrollment Office
E-mail: [email protected]
Via Faenza, 43
50123 Florence, Italy
Tel. +39 055 28 73 60 / +39 055 28 72 03 Fax + 39 055 23 98 920
The following are required to apply for the LdM Italian
Language Programs:



Application Form – completed and signed
Proof of Payment
Copy of your passport
PERSONAL INFORMATION
 Female
Last Name___________________________________________
First Name ___________________________
Current University/College______________________________
Profession____________________________________________
 Male
Country of Citizenship___________________________________ First Language________________________________________
Date of Birth (dd/mm/yy) ________________________________
Passport Number______________________________________
City/State of Birth _____________________________________
Country of Birth________________________________________
Permanent Address___________________________________________________________________________________________
City ________________________________________________
Country______________________________________________
Postal Code__________________________________________
E-mail_______________________________________________
Phone / Fax__________________________________________
Mobile phone__________________________________________
EMERGENCY CONTACT
Name______________________________________________
Relationship__________________________________________
Phone / Mobile_______________________________________
E-mail________________________________________________
Have you previously studied at Lorenzo de’ Medici Institute?
 Yes
 No
How did you find out about our Programs?
 Family/friend  LDM website  Istituto Italiano di Cultura  Student
 Google Ad
 Teacher
 Other ___________________________________________________________________________________________________
PRIVACY POLICY
LdM is registered to hold your personal data in accordance with Italian Law 675/1996 and D.Lgs.196/2003 on privacy. This information will be used
for administrative purposes and will not be given to any third party. I hereby agree to comply with the above regulations and I authorize the use of my
personal information by Lorenzo de’ Medici.
I allow LdM exclusively to collect, publish and use for purposes of advertising and promotion that are not detrimental to my dignity or reputation:
1) my image in photographic, video or digital content; 2) my own writings, figurative works, music, art, and creative projects; 3) my name in
conjunction with interviews and statements in relation to LdM. I permanently waive all rights of compensation for the aforementioned content
generated in the period of enrollment at LdM, which may be reproduced either in its entirety or in part, in the form of any multimedia content, and
may be published on the following website www.ldminstitute.com and/or in other domains related to LdM in Italy and abroad.
Student signature
________________________________________________ Date _______________
Lorenzo de’ Medici – Florence, Tuscania, Rome
AP_IT_16 08.03.2016
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 TUITION 2016 & PROGRAM SELECTION 
Select (
) the desired Program and Location:
GROUP COURSES
In case the minimum number of participants for Group Courses (3) is not reached, LdM reserves the right to reduce the number
of teaching hours.
COURSE TITLE
NUMBER OF HOURS
TUITION
Extra week
€ 160
 Florence
 Florence
 Florence
 Florence
 Florence
 Florence
 Florence
 Florence
 Florence
3 hrs. per day, Monday-Thursday,
for 1 month = 48 hrs.
€ 450
 Florence  Tuscania  Rome
4 hrs. per day for 2 weeks = 40 hrs.
€ 360
4 hrs. per day for 3 weeks = 60 hrs.
€ 535
4 hrs. per day for 1 month = 80 hrs.
€ 660
Superintensive
4 hrs. per day for 2 months = 160 hrs.
€ 1.195
Florence (all year long)
4 hrs. per day for 3 months = 240 hrs.
€ 1.710
4 hrs. per day for 4 months = 320 hrs.
€ 2.285
4 hrs. per day for 5 months = 400 hrs.
€ 2.730
4 hrs. per day for 6 months = 480 hrs.
€ 3.140
Intensive
Florence, Tuscania & Rome (June & July)
AVAILABLE CAMPUSES
INDIVIDUAL COURSES
-By request, these courses can be organized to include art history visits and lunch with the teachers (additional costs may apply).
Individual Lessons (One-to-One)
Semi-Individual lessons
(Two students + One Teacher)
One hour is 50 mins long.
Minimum 5 hrs, maximum 40 hrs.
Schedule to be coordinated
with Italian Department
Minimum 5 hrs, maximum 40 hrs.
Schedule to be coordinated
with Italian Department
€45 per hour
 Florence  Tuscania  Rome
Number of Hours per week_______
€35 per person
per hour
 Florence  Tuscania  Rome
Number of Hours per week_______
CERTIFICATION COURSES - Florence
Individual courses to prepare students for Proficiency Tests of Italian as a Second Language are available upon request.
COMBINATION COURSES
Combo (Group + Individual)
add 1 hr. of individual lesson/day
for 1 week = 5 hrs.
€200
 Florence  Tuscania  Rome
ITALIAN CULTURE COURSES
Italian Culture (ITC courses)
(All LdM sites)
At all LdM sites we offer courses on different aspects of
Italian culture taught in Italian language, for example
Italian for Tourism, Italian through Cooking, Art History
etc. These courses require a specific level of Italian
language (from A1 to C1) and are offered on a semester
basis (Jan-May and Sept-Dec) and on a monthly basis
(June and July sessions) in accordance with the yearly
course planning. For further details regarding the program,
requirements and availability, please contact
[email protected] or [email protected]
TERM___________________
 Florence  Tuscania  Rome
LDM FLORENCE COOKING COURSES
Italian Cooking Lessons
(Florence)
Lorenzo de’ Medici – Florence, Tuscania, Rome
LdM Florence offers "Lunch/Dinner with the Chef" (cooking
demonstrations), as well as cooking lessons at discounted
rates for LdM students. Lessons are in Italian or English
and take place at the Cucina Lorenzo de' Medici in the
charming location of the Mercato Centrale, a historic
market right in the heart of Florence. Individual lessons in
Italian or English are also available upon request.
Please check http://www.ldminstitute.com/en/main/italianlanguage/.
Enrolments for cooking courses are
done on site at LdM.
AP_IT_16 08.03.2016
2
REGISTRATION POLICIES
-Course attendance is a primary requirement for a responsible learning experience at LdM.
SELECT DATES
Please reference the Italian Language Dates online: http://www.ldminstitute.com/wp-content/uploads/2015/02/DATES_2016_italiano.pdf
Elementary 1 level Group Courses start on the Monday of the first week of each month.
Course 1 ___________________________ Start Date _________________ End Date__________________
Course Title
Day
Month
Year
Day
Month
Year
Course 2 (if desired) ___________________________ Start Date _________________ End Date__________________
Course Title
Day
Month
Year
Day
Month
Year
Notes:_______________________________________________________________________________________
ITALIAN LANGUAGE PROFICIENCY
Have you ever studied Italian?
 Yes  No
If YES:
How many hours? _____________________________________Where? _______________________________________________
When / How long ago? ____________________________ Which level did you attend?_____________________________________
Indicate if possible your self-assessed language level according to the Common European Framework Reference for Language Levels:
 A1
 A2
 B1
 B2
 C1
 C2
Non-beginning students will take a placement test at LdM to confirm their level.
HOUSING POLICIES
- For students seeking LdM Housing, the Housing Request Form and Housing Deposit must be submitted along with this application.
- The Housing Request Form can be downloaded at: http://www.ldminstitute.com/files/admissions/HR_IT_16.pdf


I would like LdM to arrange housing for me (Please complete the Housing Request Form)
I will make my own living arrangements
PAYMENT
If a student visa is required, LdM is obligated to receive the full balance of tuition before releasing an official “Acceptance Letter,” which is one of the
required documents for the student visa application.
If a student visa is not required, a deposit of 50% of the total tuition is due with the application. The remaining balance of the tuition is due 20 days prior
to the start of the course.
Registration Fee - Upon enrollment, the tuition/deposit must be paid along with a non-refundable €50 registration fee. This registration fee will remain valid
for 12 months, allowing students to enrol in courses at any time throughout that period.
Returning Students - Previous LdM students are eligible for a 10% discount on tuition fees.
Course materials are not included in the tuition costs.
CALCULATE COST
Tuition Subtotal (see Program Selection above): _______________
If a student visa is required:
Tuition Subtotal
Registration Fee €50
Housing Security Deposit
€150
For students who are securing housing through LdM.
TOTAL due with application *
If using credit card – add a 2% convenience fee
Lorenzo de’ Medici – Florence, Tuscania, Rome
AP_IT_16 08.03.2016
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If a student visa is NOT required:
Deposit due with application (= 50% of Tuition Subtotal)
Registration Fee
€50
Housing Security Deposit €150
For students who are securing housing through LdM.
TOTAL due with application *
BALANCE due 20 days before beginning of course
(= 50% of Tuition Subtotal) *
* If using credit card – add a 2% convenience fee for each payment
PAYMENT METHOD
Choose (



) one of the following methods, specifying payment in Euro:
Secure on-line credit card payment (VISA, MASTERCARD, AMERICAN EXPRESS, JCB) at:
http://pay.ldminstitute.com
All credit card transactions are subject to a 2% convenience fee at the time of payment.
Bank cashier’s check or international money order payable to:
Lorenzo de’ Medici s.r.l.
Attn: Italian Language Enrollment Office
Via Faenza, 43
50123 Firenze - Italia
Bank transfer to the following bank account (please provide LdM with a copy of the bank receipt as proof of payment):
Name: Lorenzo de’ Medici
Account #: 85450
Bank: Cassa di Risparmio di Firenze – Sede
Address: Via Bufalini, Firenze – ITALY
ABI code: 06160
CAB code: 02800
SWIFT code: CRFI IT 3F
IBAN code: IT70U0616002800000085450C00
All bank charges shall be paid by the student.
CANCELLATION POLICY
If an official cancellation notice is received by LdM:
- 20 days or more before the start of the term, the student will be liable for 30% of the tuition.
- 19 to 7 days before the start of the term, the student will be liable for 50% of the tuition.
- 6 days to the beginning of the term, no refund will be given.
After classes start, no refund will be due to students who do not attend or who withdraw from LdM.
Fees are not transferable to other persons.
Students will receive the refund minus the cost of any transfer fees.
NOTE: Only in the case that a student is unable to obtain the visa to enter Italy, the previous cancellation policy does not apply (see Student Visa link
below).
I have read, understood, and will abide by the above Lorenzo de’ Medici policies and regulations.
My signature below also attests to the fact that I have been made aware of the information regarding:
Student Visa: http://www.ldminstitute.com/en/apply/student-visa
Permit of Stay: http://www.ldminstitute.com/en/apply/student-visa/permit-of-stay
Health Insurance: http://www.ldminstitute.com/en/apply/health-insurance
Student signature
________________________________________________ Date _______________
PRINT STUDENT NAME_________________________________________
Lorenzo de’ Medici – Florence, Tuscania, Rome
AP_IT_16 08.03.2016
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