| Student Name* : |
|
| Age: |
|
| Male: |
|
| Female: |
|
| Nationality* : |
|
| Passport Number* : |
|
| Mailing address : |
|
| Check Spanish Level:* |
Complete Beginner
Advanced Beginner
Intermediate
Advanced |
| Where have you studied
Spanish before: |
|
| How long*: |
|
| What languages do
you speak: |
|
| Program chosen* : |
|
| Number of weeks* : |
|
| Start date * : |
|
| Lodging* : |
Yes
No |
| Homestay |
Yes
No |
| Any special Health
needs* : |
|
| Special family requirements
* : |
|
| Smoking *: |
Yes
No |
| Children * : |
Yes
No |
| Pets * : |
Yes
No |
| Airport pick up information
* : |
|
| Arrival date: * |
|
| Arrival time: * |
|
| Airline: |
|
| Flight number : |
|
| Please state any allergies
or preferences you might have (children, pets, smoking, vegetarian
food, etc.) |
|
| Comments |
|
