Summer Spanish Immersion

Application Form

General Information

*Name:

*Date of Birth:

(MM/DD/YYYY)

*Address:

*City:

*State:

*Country:

*Zip Code:

*Telephone

( ) -

*Email

Occupation

*Emergency contact

*Relation:

*Emergency Telephone:

( ) -

Course Information

Choose course level:

Beginning "I know hardly any Spanish at all. If I took classes in high school or college I've forgotten everything. I need to start at the beginning."

Intermediate "I can basically speak in the present. My vocabulary at one time was extensive but I've forgotten many words. I need more practice with verb tenses. I can basically understand a text like the newspaper."

Advanced "I am communicative in Spanish. I might have some trouble with conjugating verb tenses. I want practice reading literature and having advanced discussions in Spanish."

Language Level Comments:

Housing start date:

Housing end date:

*Class start date:

*Class end date:

Flight Arrival/Departure
(if known):

Special housing considerations

Other special requirements

Optional Information

How did you hear about Habla?

What do you hope to get out of your experience at Habla?

What would you like to tell us about yourself?

For more information on cost, payment, and refunds, please download the Summer Spanish Immersion Form Terms and Conditions.

PREFERRED PAYMENT METHOD: The initial $ 150 deposit must be paid via PayPal. The remaining balance is due four weeks before the program begins. Homestays can be paid in traveler's checks or cash when you arrive. After you complete this form click on Payments to pay either the deposit or the program balance.