Study and Learn Spanish in Costa Rica at CRLA Language School


	Registration Form

PERSONAL INFORMATION

Name:

A value is required.(required)

Last Name:

A value is required.(required)

Occupation:

Company:

Place of birth:

Date of birth:

(month/day/year)

Sex:

Address:

Work Phone:

Home Phone:

Fax:

Email:

A value is required. (required)

What languages do you speak?

Have you received Spanish classes before?

If yes, where?

For how long?

In what level of Spanish do you consider to be at this moment?

How did you hear about the C.R.L.A.?

Former Student
Internet
Magazine/Book
Other Source	Please specify

ENROLMENT

Program you are enrolling for:

Number of weeks:
Type of classes:
Hours per day:
Days per week:
With homestay:

Dates you will be at the academy?

From:	(month/day/year)
To:	(month/day/year)

Will you require a grade or transcript?

If yes, university/college name:

Do you want to be picked up at the airport?

Date:

(month/day/year)

Time:

: (hour : minute)

Airline:

Flight #:

HOMESTAY INFORMATION

What type of lodging do you prefer:

Room:
Atmosphere:
Food:

Do you mind if
your family

Has Children:
Smokes:

Do you smoke?

Do you have allergies or other relevant health problems? (Specify)

Other preferences and comments:

Most Costa Rican families have pets. If you have any pet allergies or a strong dislike for pets please indicate this.

Dates you will be at the home stay:

In:	(month/day/year)
Out:	(month/day/year)

NOTE: The information provided will be used to make the best possible match between the student and the family. Although we try to meet as many of the student's desires, we do not require that the family or the Academy provide everything that the student has checked off.

What do you hope to gain from this experience?

Date:

(month/day/year)

PERSON TO NOTIFY IN CASE OF EMERGENCY

Name & relation to student:

Address:

Home Phone:

Work Phone:

Approximately 3 weeks prior to your class start date, you will be sent your host family information, emergency phone numbers and tips to help you get ready for your trip. In one or 2 days (or 3 days during the weekend), you will receive an e-mail verification upon receipt of your application.

spanish@crla.co.cr
Toll free: 1 (866) 230 6361 (in the US)
Tel: +(506) 2280-1685, 2280-1739, 2280-2548 Fax: (506) 2280-2548
P.O. BOX 1966-2050, SAN JOSE, COSTA RICA