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Enrollment form

Please fill out this form with your contact information
Note: * are required fields

Personal Information
First Name*
Last Name*
Current Address
City
State
Zip
Phone*
Fax
E-mail*
Nationality
Age
Sex	Male Female
Occupation
Place of work
Level of fluency in Spanish*
	Beginner Intermediate Advanced
Program Information*
Intensive course
Private classes

Accomodation (Homestay)
	Required Not required
Flight Information
Estimated date of arrival
Time of arrival
Airline
Flight #
Airport transfer	Required Not required
IMPORTANT: WE OFFER AIRPORT TRANSFER ONLY WITH HOMESTAY OPTION.

How did you find out about the school?
	Former student School's brochure Newspaper Travel Guide Internet Other

Please or

If the form is not working properly, please contact us at spanish@universal-edu.com Print out this form, fill it out and fax it to +(506) 2223-9917

Contact Information:
Learn Spanish - Medical Spanish Academy
PO Box 751-2150 Moravia
San Jose, Costa Rica
Tel: +(506) 2223-9662
Fax: +(506) 2223-9917
Address: Avenida 2da, calle 9. Downtown San Jose
E-mail: info@medicalspanishacademy.com

Enrollment form

Personal Information

Program Information*

Flight Information

How did you find out about the school?