Enrollment

Personal Information

First Name* (required)

Last Name* (required)

Current Address

City* (required)

State* (required)

Country* (required)

phone* (required)

Fax* (required)

Email (required)

Retype Email (required)

Nationality* (required)

Age* (required)

Gender* (required)

Male Female

Occupation* (required)

Place of work* (required)

Level of fluency in Spanish* (required)

Beginner Intermediate Advanced

Program Information

Program: * (required)

Select OneIntensive (4 hrs/day)Group PLUS (4+2 hrs/day)Private LessonsMedical Spanish ProgramBusiness Spanish ProgramSpanish for teachers

Number of weeks of classes * (required)

Select OneOne WeekTwo WeeksThree WeeksFour WeeksFive WeeksSix WeeksSeven WeeksEight WeeksNine WeeksTen WeeksEleven WeeksTwelve WeeksFour MonthsFive MonthsSix Months

Number of private hours (if needed)* (required)

Number of weeks of Homestay: * (not required)

Select OneOne WeekTwo WeeksThree WeeksFour WeeksFive WeeksSix WeeksSeven WeeksEight WeeksNine WeeksTen WeeksEleven WeeksTwelve WeeksFour MonthsFive MonthsSix Months

Flight Information & length of visit in Costa Rica

Estimated date of arrival* (required)

Time of arrival* (required)

Airline* (required)

Flight* (required)

Airport transfer* (required)

Required Not Required

IMPORTANT: AIRPORT TRANSFER HAS AN EXTRA COST OF $35 USD

Length of stay in Costa Rica * (required)

If not choosing home stay program, name of hotel* (required)

Airline* (required)

Estimated date to start Spanish lessons* (required)

How did you find out about the school?

Airport transfer* (required)

Former student
School's brochure
Newspaper
Travel Guide
Internet
Other

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