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)

Mayan Culture (Merida)	Incan Culture (Peru)
Politics/Economy	Spanish American Literature
Conversation	Business/Spanish for Business
Religion	Education/Spanish for Teachers
Art History	Yucatán 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 (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.

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

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)

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.)

 

Between Elementary & Intermediate (You feel confident speaking in the present. You may understand when people speak about past events; however, are not confident constructing speech in the past tense.)

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.)

 

Between Intermediate & Advanced (You feel confident speaking in the present, past & future. You have a general idea about. You have been introduced to the subjuntive mood, but do not feel confident with its usage.)

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. You have studied the subjuntive mood.)

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

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)