| SECTION ONE - Your start date: |
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| Date to begin class: Length of study:
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| SECTION TWO - About yourself: |
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| Email Address: | |
| Alternate Email: | |
| a second email address for you is helpful |
| Name: | |
Complete
Mailing
Address: | |
| Primary Phone: | |
| Fax: (optional) | |
| Age: Month/Day of birth:
Female Male |
| Occupation/where you work - Retired - Field of study/school: |
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| Why do you want to learn Spanish? |
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| What contact, if any, have you had with the Spanish language? If so, for how long? Include date of previous attendance at Chac-Mool, if applicable. |
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| SECTION THREE - Info for your private class instructor |
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| Type of class:
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| In what area of your field would you like your private Spanish class to be focused?
Sample choices: emergency medicine, nursing, pediatrics, hospice care, immigration law, mental health social work, teachers proficiency testing, etc. (be specific, it will
help our instructor prepare your individualized course).
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| Give a number from 1 (highest) to 10 (lowest) your class priorities (or n/a): |
| Vocabulary: | |
| Specialized Field Trips: | |
| Reviewing/Writing/Interpreting Documents: | |
| Situational Role Playing: | |
| Lecture Preparation: | |
| Volunteering while in Cuernavaca: | |
| Other (details please): |
| SECTION FOUR - FOR OUR HOUSING DIRECTOR if not needed proceed to Section Five: |
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| Date to begin housing: Date to depart housing: |
| What kind of living arrangements would you like? CHECK YOUR CHOICE: |
With a host family, including 3 daily meals:
Single Room with Private Bathroom
Single Room with Shared Bathroom
Shared Room with Private Bathroom (not available if school assigns your roommate)
Shared Room with Shared Bathroom
Guesthouses are limited, if not available you will be assigned a host family
Guesthouse Rental - no meals
Guesthouse Rental - with meals
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| Estimated accommodations arrival time:
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| ie. 2-3 pm. allow 15-45 min for immigration + 1 ¾ hour for bus |
| Do you smoke?
No Yes, outdoors |
| Are vegetarian meals requested? |
| No Yes No red meat
State other desired requirements below: |
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| SECTION FIVE - other helpful info: |
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| Your cell number, if traveling to Mexico with your cell phone: |
| Is a private Mexico City airport pick up desired?
No Maybe Yes |
| If Yes, arriving flight info if known: |
| Transport back to the airport should be arranged while at the school |
| Interests: |
History Politics
Education Literature
Arts and Crafts
Religion Mexican Traditions Mexican Music
Other?
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| List your home school if college credit is desired (mailing fee applies): |
| Desire Continuing Education Units of Credit? State Profession: |
| If you found us online, where did you learn about us? |
| If a friend recommended you, can you tell us who it was? |
| Your emergency contact persons name and phone number: |
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| SECTION SIX- Questions or comments: |
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| SECTION SEVEN - TO SUBMIT PLEASE TYPE IN WORDS AS SHOWN BELOW: |
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