Registration Form

PERSONAL INFORMATION
Name: (required)
Last Name: (required)
Occupation:
Company:
Place of birth:
Date of birth: (month/day/year)
Sex:
Address:
Work Phone:
Home Phone:
Fax:
Email: (required)
What languages do you speak?
Have you received Spanish classes before?
If yes, where?
For how long?
In what level of Spanish do you consider to be at this moment?
How did you hear about us?
Former Student
Internet
Magazine/Book
Other Source
ENROLLMENT
Program you are enrolling for:
Number of weeks:
Type of classes:
Hours per day:
Days per week:
With homestay:
Dates you will be at the academy?
From: (month/day/year)
To: (month/day/year)
Do you want to be picked up at the airport?
Date: (month/day/year)
Time: : (hour : minute)
Airline:
Flight #:
HOMESTAY INFORMATION
What type of lodging do you prefer:
Room:
Atmosphere:
 
Children:
Pets:
Other Preferences:
Do you have allergies or other relevant health problems? (Specify)
NOTE: The information provided will be used to make the best possible match between the student and the family, although we try to meet as many of the student's desires, we do not require that the family or the Academy provide everything that the student has checked off.
What do you hope to gain from this experience?
Date: (month/day/year)
PERSON TO NOTIFY IN CASE OF EMERGENCY
Name & relation to student:
Address:
Home Phone:
Work Phone:

I have read "terms and conditions."

    

Fax and Voice mail in the U.S. 1 (610) 643-1782

Tel in Mexico +52 1 (777) 159-4555