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