Student Information
SURNAME: FIRST NAME:
NATIONALITY: PASSPORT / IDENTITY CARD:
DATE OF BIRTH (DAY/MONTH/YEAR): SEX: MALE FEMALE
OCCUPATION:
HOME ADDRESS: POST CODE:
CITY: STATE / PROVINCE: COUNTRY:
E-MAIL: PHONE: FAX
Courses Information
WHICH LEVEL DO YOU THINK YOU HAVE?:
WRITING: Chose your level Beginner (A1) Elementary (A2) Intermediate (B1) High Intermediate (B2) Advanced (C1) Superior (C2) READING: Chose your level Beginner (A1) Elementary (A2) Intermediate (B1) High Intermediate (B2) Advanced (C1) Superior (C2) CONVERSATION: Chose your level Beginner (A1) Elementary (A2) Intermediate (B1) High Intermediate (B2) Advanced (C1) Superior (C2)
CHOSEN COURSE:
L01 L02 L03 L04 L05 D061 D062 D063
N07 N08 N09 E10 E11 E12 E13
DATES COURSE:
FROM (DAY/MONTH/YEAR): TO (DAY/MONTH/YEAR): NUMBER OF WEEKS:
REMARKS:
OPTIONAL CLASSES:
O1 O2 O3 O4 O5 O6 O7 O8 O9 O10 O11 O12 O13 O14
Accommodation Information
¿LODGEMENT DESIRED? YES NO
HOST FAMILLY
SINGLE ROOM DOUBLE ROOM HALF BOARD FULL BOARD
SINGLE ROOM DOUBLE ROOM
HALF BOARD FULL BOARD
STUDENT APARTMENT
TIPE A TIPE B SINGLE ROOM DOUBLE ROOM
TIPE A TIPE B
RESIDENCE ( FULL BOARD)
HOTEL
DATES ACCOMMODATION
ARRIVAL DATE ACCOMMODATION (DAY/MONTH/YEAR) ARRIVAL TIME ACCOMMODATION (AROUND)
FROM (DAY/MONTH/YEAR) TO (DAY/MONTH/YEAR) NUMBER OF WEEKS
REMARKS: SPECIAL REQUERIMENTS ACCOMMODATION (ALLERGY, SPECIAL DIET...)
IN CASE OF EMERGENCY, CONTACT:
NAME
PHONE
E-MAIL
SPECIAL TRANSPORT SERVICE
WOULD YOU LIKE SPECIAL TRANSPORT SERVICE AIRPORT MADRID/BARAJAS- SALAMANCA? YES NO
NUMBER OF PASSENGERS IF YES, ARRIVAL'S DATE TO MADRID (DAY/MONTH/YEAR) ARRIVAL'S SPANISH TIME
ORIGIN FLIGHT NUMBER AIRLINE
NOTE: this service has to be paid in advance with the pre-enrollment fee..
ENROLLMENT AND PAYMENT TERMS
To be enrolled at the Institute, it is necessary for a correctly filled -in application form and a pre-enrollment fee of 150 euro to be sent to the Institute. The pre-enrolment fee will be deducted from the total course fee which must be paid in Salamanca on the first day of the course. If you wish, the total course fee can be paid from the country of origin. The money can be sent as follows:
1. By bank transfer to our account (in this case, the banker's charges are borne by the student) The transfer should be made to:
INSTITUTO ESPAÑOL DE SALAMANCA BERCEO C/ PEDRO COJOS, 7 37001 SALAMANCA ESPAÑA
2. By banker's draft in Euro made out against a Spanish bank in favour of Instituto Español de Salamanca. Registered mail should be used:
3. By means of giro post in Euro in the name of the Instituto Español de Salamanca, to our address.
NOTE: upon arrival in Salamanca to BERCEO, the student must submit proof of registration and proof of payment or pre-registration. PREFERRED MEANS OF PAYING THE ENROLLMENT FEE
BANK TRANSFER DATE OF THE TRANSFER (day/month/year)
INTERNATIONAL CHECK DATE YOU HAVE SENT IT (day/month/year)
POSTAL ORDER DATE OF THE POSTAL ORDER (day/month/year)
Remarks: