Registration form

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:  

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