COSI Spanischschule in Costa Rica

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COSI San José

COSI Manuel Antonio

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ANMELDUNG

I. Personal Information
First name:		Last name:		Nationality:
Birthday:		Sex:	Male Female	Profession:
Street Address:				Zip code:
State/Province:		City:		Country:
Telephone (home):		Fax:		Telephone (work):
Passport number#:		E-mail:		Ethnic origin:

II. Arrival Details
Airport pick up:	Yes No	Arrival date:		Time:
Airline:		Flight #:		Contact in case of emergency:
Medical concerns:	Yes No	Add Info :

III. Host Family Information
In San José:	Yes No	First day:		Last day:
In Manuel Antonio:	Yes No	First day:		Last day:
Do you mind if the host family has:
Smokers?	Yes No No pref.		Children?	Yes No No pref.
Pets?	Yes No No pref.		Another student?	Yes No No pref.
Are you a smoker?	Yes No
Hobbies / Interests:			Additional comments:

IV. Program Information
Select the type of program you want (you can select more than one) and its starting and ending dates: (includes airport pick up and bus transfer from San José to Manuel Antonio)
San José Program
Option A: group 4 hrs/day	Starting date:	Ending date:
Option B: private tutoring 4 hrs/day	Starting date:	Ending date:
Option C: group 4 hrs. + 2hrs. private tutoring	Starting date:	Ending date:

Manuel Antonio Program (Beach and Rainforest site)
Option D1: beach group.	Starting date:	Ending date:
Option D2: beach private tutoring.	Starting date:	Ending date:
Option D3: beach group + 2 hrs. private tutoring.	Starting date:	Ending date:
Comments regarding Program Information:

V. Apartment in San José (100 mts from COSI, 3 bedrooms (double bed in each), full furnished, includes cable with internet access and TV)
Sharing apt (priv.room):	$30/night; $160/week; $500/month (+30% if it is a double)	Starting date:
Whole apt:	$60/night; $350/week; $1200/month	Ending date:

VI. Other Information
Spanish level:		Other languages spoken:
How did you find out about COSI?:		Other information:

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