REQUIRED FIELDS*
|
|
| FIRST NAME* |
LAST NAME* |
|
|
|
| EMAIL* |
|
|
|
|
| STREET ADDRESS* |
|
|
|
|
| CITY* |
STATE* |
|
|
|
| ZIP* |
COUNTRY* |
|
|
|
| HOME PHONE* |
Work Phone |
|
|
|
| Fax |
NATIONALITY* |
|
|
|
| Date of Birth |
Occupation |
|
|
|
| Sex: Female Male
|
Marital status: Single Married
|
| Emergency Contact Name & Phone Number |
How did you hear about us? |
|
|
|
| SPANISH LANGUAGE LEVEL(This is just to give us an idea of your level, but your placement will be determined by an exam given upon your arrival.)
|
ESTIMATED LANGUAGE LEVEL*
Beginning Intermediate Advanced
|
NUMBER OF YEARS YOU HAVE STUDIED SPANISH*
What other languages do you speak?
|
Comments on your Spanish level:
|
|
| PROGRAM INFORMATION---Immersion Program
(Note: Courses begin on Mondays and end on Fridays. If you are participating in the Homestay Program, your accommodation will begin on a Sunday and end on a Sunday unless you are signing up for the Design-Your-Own Immersion Program)
|
Course Start Date
|
Course End Date
|
Number of weeks of study
|
|
Reason for choosing school:
|
|
| Expectations: |
|
|
|
| HOMESTAY INFORMATION
|
Arrival Date
|
Departure Date
|
Stay with a family?
Yes No
|
Number of homestay weeks
|
| If your answer is no, please disregard questions in "Homestay" section.
If your answer is yes, please answer the following questions*
|
Room Type
Private Room Shared Room
|
Are you traveling with a companion?
Yes No
|
| If YES... |
|
Will you be sharing a bedroom with him or her?
Yes No
|
Will you be sharing a bed with him or her?
Yes No
|
Companion’s Name:
|
|
Do you smoke?
Yes No
|
If staying with a companion, does your companion smoke?
Yes No
|
Do you prefer a non-smoking household?
Yes No
|
|
| DIETARY INFORMATION FOR STUDENTS STAYING WITH A FAMILY & SHARING MEALS
|
Which meals will you be sharing with a family? choose one:
No Meals Breakfast only Breakfast, lunch, dinner
|
Please describe any dietary restrictions?
|
| HOTEL ACCOMMODATIONS
|
| If you choose not to stay with a host family, we can arrange a hotel room for you.Would you like us to make hotel reservations at hotel Hotel Posada Tonala (Mid-range Rooms $40 one person, $50 two persons)? Yes No
|
Room type
one double bed two double beds
|
Number of people in room:
|
Do you prefer a non-smoking room?
Yes No
|
|
| Please type the numbers and letters:
|
|
 |
|
|
|
|
 |
|
