INSTITUTE OF MODERN SPANISH ONLINE REGISTRATION
Merida, Yucatan, MEXICO
City State
Country Zip Code
Telephone: E-mail:
Personal Information: Date of birth: Marital Status: -Marital Status- Single Married Divorced Separated Window/er Religion: Profession:
Allergies:
Special eating preferences / food needs:
Special Interests (Important for Host Families & Teachers):
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)
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 (select one) (US$10.00 charge) Arrival date: Arrival time: AM PM (select one) Airline: Flight Number: Description of alternative transportation arrangements (i.e. bus from Cancun, etc.):
Departure date & time:
Transportation to airport for departure is not included in Airport Fee.
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? Yes No
If so, have you had your credit transfer requested preapproved at your home school? Yes No
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)? Yes No
If so, which one(s)? How would you rank your current Spanish language ability level? (Check One)
Cultural Excursions/Trips:
I am interested in participating in the following cultural excursions/trips (Check to show interest.):
I wish to register for... Instruction:
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 20 + weeks of private / group (select one) instruction for 20 / 25 (select one) hours per week. Monday Start Date: January February March Abril May June July August September October November December , 2004 2005 2006 2007 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 20 + weeks of intensive instruction (40 hours per week - Mérida Only) Monday Start Date: January February March Abril May June July August September October November December , 2004 2005 2006 2007
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 20 + weeks of private / group (select one) instruction for 20 / 25 (select one) hours per week. Monday Start Date: January February March Abril May June July August September October November December , 2004 2005 2006 2007
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 20 + weeks of intensive instruction (40 hours per week - Mérida Only) Monday Start Date: January February March Abril May June July August September October November December , 2004 2005 2006 2007
Housing:
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 20 + weeks of private plus / private / shared (select one) housing 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 20 + additional days of private plus / private / shared (select one)
Arrival Date: January February March Abril May June July August September October November December , 2004 2005 2006 2007 Departure Date: January February March Abril May June July August September October November December , 2004 2005 2006 2007
I wish to share housing with:
Other special housing requests:
Special Programs Winter Studies Summer Session
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)
YOUR REGISTRATION IS NOT COMPLETE UNTIL YOU HAVE SECURED IT WITH A US$100.00 NON-REFUNDABLE DEPOSIT. PLEASE CALL OR FAX YOUR CREDIT CARD INFORMATION OR PERSONAL CHECK INFORMATION (U.S. BANKS ONLY) TO COMPLETE YOUR REGISTRATION. ONLINE PAYMENT IS ALSO AVAILABLE.
CALL FROM U.S. TOLL FREE 1-877-463-4MERIDA (463-7432) OR INTERNATIONAL TO MERIDA (529) 926-2935
U.S. FAX NUMBER (775) 213-0406 (Credit Card Payment form available at http://www.modernspanish.com/ccpayment.html; Personal Check Payment from available at http://www.modernspanish.com/pcpayment.html))
Clicking the submit buttom indicates that you have read and agree with the Policies and Conditions Thank you for your time. --Institute of Modern Spanish Staff If applicant is under the age of 18, Parental Signature is REQUIRED. Please do not use Online Registration. Print registration form (www.modernspanish.com/registration.html) Return to Institute of Modern Spanish Index © 1995-2004 Instituto de Español Moderno