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Institute of Modern Spanish
-- Registration Form
http://www.modernspanish.com
Spanish language and Mexican culture studies in Mérida, Yucatán, México
Please
PRINT Registration Form. Complete and sign the Registration
Form, and send with non-refundable US$100.00 deposit (applicable
toward total program cost) or credit card payment form to:
Institute of Modern Spanish, U.S. Registration, 413 Interamerica
Blvd.WH1, PMB MX 018-108, Laredo, TX 78045 OR Fax (775) 213-0406.
Last name: _________________________________________
First name: _______________________________________________________
Street Address: ____________________________________________________
City, State, &
Zip: ___________________________________________________
Telephone: _______________________________________________________
E-mail: ________________________________________________
Personal Information:
Date of birth: ___________________ Marital Status: ______________
Religion: _________________ Profession: ______________________
Allergies: _________________________________________________________
Special eating
preferences / food needs: _________________________________
Special Interests: ___________________________________________________
How did you
become interested in studying at the Institute of Modern Spanish?
_________________________________________________________________
Mexican Culture
Interests:
In additional to Spanish language study, what specific aspects of
Mexican culture are you interested in learning more about? (check
all that apply)
| _____ Yucatan
History |
_____ Literature |
_____ Education |
| _____ Mayan Culture |
_____Conversation |
_____ Religion |
| _____ Politics/Economy |
_____ Business |
_____ Art/Art
History |
In case
of an emergency, who should we contact?
Name: ___________________________________________________________
Relation to self: ____________________________________________________
Address: _________________________________________________________
Telephone
(home): _________________ Telephone (work): __________________
E-mail: ___________________________________________________________
Arrival information (to Merida's airport):
I want to be picked up at the airport: Yes / No (circle
one) (US$10.00 charge)
Arrival date: _________ Arrival time: _________ AM / PM
Airline: _____________ Flight Number: _______
Description of alternative transportation arrangements (i.e. bus
from Cancun, etc.):
_________________________________________________________________
Departure date
& time: ______________________________________________
Mexican Family
Homestay includes the weekends before and after study at the Institute
of Modern Spanish. You are welcome to arrive earlier than Saturday
or stay later than Sunday; each additional day of Shared Accommodations
is US$20.00; each additional day of Private Accommodations is US$25.00.
School Information:
If you are a student, what school do you attend? ____________________________
Major (s) ______________________ Minor(s) ____________________________
Year in School _________________
What are your career plans?___________________________________________________________
Do you plan to
receive college
credit for your Institute of Modern Spanish course work? ______________________
If so, have you
had your credit transfer
requested preapproved at your home school? _____________________________
Language Information:
What experience
do you have with the Spanish language? (i.e. What classes have you
taken? When?)
________________________________________________________________
________________________________________________________________
What is your native language? _________________
Do you speak any other language(s)? ______ If so, which one(s)?
______________
How would you rank your current Spanish language ability level?
(Circle One)
Beginner (You have no formal knowledge of the language.
You may know a few set phrases. You do not understand spoken
Spanish.)
Elementary (You know many set phrases pertaining to yourself
and present situations. You generally understand nontechnical
speech when presented clearly.)
Intermediate (You are able to construct meaningful utterances
about yourself and present situations. You may also be able
to communicate about past and future events. You understand
spoken Spanish when presented clearly--mostly in social contexts.)
Advanced (You are able to construct meaningful utterances
about present, past, and future. You may also be able to communicate
about hypothetical situations. You understand the majority of
spoken Spanish when presented clearly in almost all contexts.)
Cultural Excursions/Trips:
I am interested
in participating in the following cultural excursions/trips
(Check to show interest.):
_____
Dzibilchaltún
(Mayan ruins and museum) |
_____
Progreso
(port town and beach) |
_____
Chichén Itzá
(Mayan ruins) |
_____
"Las Grutas"
(Cave exploration) |
_____Cancún
(Overnight trip to beach resort) |
_____
Hacienda Excursion
(Colonial homes) |
_____Celestún
(Beach and wildlife |
_____
Uxmal
(Mayan ruins & Light and Sound Show) |
_____
Other (please indicate)
____________________ |
I
wish to register for...
Instruction:
_____ weeks of
private / group (circle one) instruction for 20 / 25
(circle one) hours per week.
Monday Start
Date: ______________
_____ weeks of
intensive instruction (40 hours per week - Mérida Only)
Monday Start
Date: _______________
Housing:
_____
weeks of private / shared (circle one) housing
_____ additional days of private / shared (circle
one) |
Arrival Date:
____________________
Departure Date:
____________________
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I wish
to share housing with:
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__________________________ |
Special Programs (Inclusive Culture Programs - Merida Only)
_____ Winter
Studies Program (2 weeks)
Work Experiences
and Teaching Practicums (additional US$125.00 non-refundable
registration fee)
Work experience
_____ as indicated in the enclosed letter of application
(Merida)
Teaching
Practicum
_____ as indicated in the enclosed letter of application (Merida)
_____ Teaching
Practicum with Spanish classes (Cancun)
My signature
indicates that I have read and understood the Policies
& Conditions and that I agree to abide by said policies
& conditions.
Signature ______________________________________
Date _________________________
Signature of parent or guardian if
applicant is under the age of 18 _______________________________________
Date _________________________
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