Costa Rica Sprachschule Spanisch COSI

ENROLLMENT FORM

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:

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 (Price for a homestay in San Jos� and Manuel Antonio $120/week)
In San Jos�:	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 Jos� to Manuel Antonio)
San Jos� Program
Option A: group 4 hrs/day	Starting date:	Ending date:
Option B: private tutoring 4 hrs/day from 8-12 AM. from 1-5 PM.	Starting date:	Ending date:
Option C: group 4 hrs. + 2 hrs. private tutoring.	Starting date:	Ending date:

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

V. Apartment in San Jos� (100 mts from COSI, 3 bedrooms (double bed in each), full furnished, includes cable with internet access and TV)
Sharing apt (priv.room):	Starting date:
Whole apt:	Ending date:

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

Part of your payment helps to fund environmental protection as well as the education and well being of disadvantaged children, through donations to ASCOMOTI (protection of the squirrel monkey) and the Fundaci�n Piedad which runs schools for children from poor neighbourhoods.