If you want to enrol in our
intensive French language course
,
please fill out the following :*
APPLICATION FORM
IMPORTANT :
YOU MUST FILL IN EACH FIELD CAREFULLY OTHERWISE
THE SYSTEM WILL REFUSE YOUR FORM
Note : if you don't receive a reply within 2 working days, please contact us.
Mr
Ms
Miss
*
E-mail
*
Please use same email adress for all correspondance !
Name
*
First Name
*
Address
*
City
*
State
Zip code
*
Country
*
Tel
00+country code+phone#
Fax
Date of birth
dd/mm/yyyy
required
Nationality
USA
United-Kingdom
Germany
Switzerland
Japan
Australia
New Zealand
Canada
Norway
Sweden
Denmark
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua-and-Barbuda
Argentina
Armenia
Austria
Azerbaïdjan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fidji
Finland
France
Gabon
Gambia
Georgia
Ghana
Greece
Grenada
Guatemala
Guinea-Bissau
Guinea
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Jersey
Jordan
Kazakhstan
Kenya
Kirghizistan
Kuwait
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Madeira
Malawi
Malaysia
Maldives
Mali
Malta
Marshall
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Morocco
Mozambique
Namibia
Nepal
Netherlands
New Caledonia
Nicaragua
Niger
Nigeria
North Korea
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Porto Rico
Portugal
Qatar
Romania
Russia
Rwanda
Saint Lucia
Saint Vincent and the Grenadines
Salvador
San Marino
Sao Tome and Principe
Sardaigne
Saudi Arabia
Senegal
Seychelles
Sicilia
Sierra Leone
Singapore
Sloavakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Syria
Taiwan
Tajikistan
Tanzania
Tchetchenia
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Yougoslavia
Zambia
Zimbabwe
*
Profession
*
Mother Tongue
*
Schools attended
Degrees and Majors
Total years of French
*
Secondary
University
Some speaking knowledge:
Yes
No
*
Course level estimated:
(in spoken French)
Beginner
Beginner +
Interm.
Interm. +
Advanced
Other languages learned
Accommodation
Without
Individual room
Double room
Private studio apt.
higher standard studio apt.
higher standard 2-room apt.
*
I wish to enroll for:
Jan. 4 - Jan. 29, 2010
Feb. 1 - Feb. 26, 2010
Mar. 1 - Mar. 26, 2010
Mar. 29 - Apr. 23, 2010
May 3 - May 28, 2010
May 31 - June 25, 2010
June 28 - July 23, 2010
Aug. 2 - Aug. 27, 2010
Aug. 30 - Sept. 24, 2010
Sept. 27 - Oct. 22, 2010
Oct. 25 - Nov. 19, 2010
Nov. 22 - Dec. 17, 2010
*
Remarks
Day
Month
Year
Date of arrival
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
01
02
03
04
05
06
07
08
09
10
11
12
2008
2009
2010
2011
2012
by
(means of transport)
How did you hear about our school?
(if through searching the internet, please specify keywords used)
Your reason for learning French ?