1. Participant

Last Name: *
First Name: *
Street address, city, country:
Phone: *
Fax:
Date of Birth:
E-mail: *
Nationality: *
Sex:	male:    female:
Profession/Occupation:
Mother tongue:
Knowledge of other languages:
Age:

2- Education background

Please briefly describe your education, areas of specialization, and professional experience relevant to the Spanish course for Missionaries and Religious Organizations:

 

3. Desired Spanish Course / Previous Level

Please guide us in your knowledge of the Spanish language (which school(s), how many years, stays in Spanish speaking countries, etc.):

APPROXIMATE SPANISH LEVEL:

	1. Complete beginner		4. I am able to hold a longer conversation
	2. Knowledge of some words or phrases		5. I can deal with almost any topic
	3. I am able to hold a simple conversation		6. My knowledge is similar to the one of a native speaker

I wish to register in the following program:

	I-4		I-3		I-2		I-1
	II-4		II-3		II-2		II-1
	III-4		III-3		III-2		III-1
	IV-4		IV-3		IV-2		IV-1
	Other please specify:

First day of classes:    01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   January February March April May June July August September October November December   2007 2008

Last day of classes:    01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   January February March April May June July August September October November December   2007 2008

4. Lodging

Family homestay
No housing

First day of housing : 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   January February March April May June July August September October November December   2007 2008

Last day of housing:  01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   January February March April May June July August September October November December   2007 2008

I am smoker (Only for homestay!)	Yes No
Family with little children?	Yes No   No preference

Comments regarding special dietary requirements (vegetarian etc.) :

5. Arrival

Date of arrival:	Flight number:
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   January February March April May June July August September October November December   2007 2008
Time of arrival:	Airline:
Do you wish to be picked up at the airport on arrival?	Yes No
Please indicate a person who could be contacted in case of emergency (name, phone number, email-adress):

How did you learn about the Institute?
	Recommendation		Travel guide
	Internet
	www.123teachme.com
	agent for language travel
	agent for internship
	Information pages about Costa Rica
	travel organization
	search machines :
	yahoo google msn         altavista

CONTRACTUAL TERMS

1. The student must inform the Institute of any change in the arrival date at least 2 days before arriving. If the arrival date change is not received, the Institute will not be responsible for the airport pick up.

2. Additional days of homestay can be arranged and have an extra cost of $15 (U.S. dollars).

3. All payments will be made in U.S.dollars ($) or in the local currency. The Institute does no accept any other currency. The first day of classes full payment of the chosen course is due and has to be made at the Institute’s Direction. Our Institute accepts the following methods of payment: cash (U.S. dollars), personal checks drawn form a U.S. bank account, U.S. traveler’s checks, certified checks, international money orders, deposit on the Institut’s bank account (must be on our account one week before). We will not accept credit cards.

NOTE: Please be aware that banks in Costa Rica have very strict rules. Checks will not be accepted if they have been marked or re-written over in any form. Checks that ared damaged or torn will not be accepted either. Deposits have to be made on the following account:

Be aware that there may be fees for currency conversion and/or wire transfer, for which you are responsible. Our account must receive the full payment in US dollars some days before starting classes.

We will not accept credit cards.

4. All cancellations of registered courses must be submitted in writing at the Institute’s central offices at least one week before starting the course. No refunds will be made once the course begins. The cancellation will be made effective when the written cancellation arrives to the Institute’s central offices.