IESC Spanish School Registration
Instituto de Estudios Superiores de Coahuila
Spanish School

Bogota #35, Col. Guadalupe
CP25750 Monclova, Coahuil
Mexico
Tel : + 52 (866) 632 0028
Fax :+ 52 (866) 632 1101
E-mail: informacion@iesc.edu.mx

* Required Fields

I. Application Form

*Email Address:   
*Title:   
*First Name:   
*Family Name:   
*Address:   
*City:   
*Province/State:   
*Country:   
*Postal Code:   
*Telephone:   
*Fax:   
*Place of Birth:   
*Citizenship:   
*Passport Number:   
*Birthdate:    e.g. 1975/05/30
*What is your current level of Spanish?:   
*What is your current level of English?:   
*When do you wish to begin?:
  
*How long do you wish to study?:   
*When will you arrive in Monclova?:    e.g. 2005/01/30
*When will you leave Monclova?:    e.g. 2005/01/30
*How did you find about IESC Spanish School?   

 

II. Homestay Information

*How long will you be in your homestay?:    Months
What are your favourite sports?:    Baseball
   Basketball
   Cycling
   Sailing
   Aquatic Ski
   Soccer
   Swimming
   Tennis
   Volleyball
   Other
What are your favourite recreational activities?:    Art
   Camping
   Dancing
   Movies
   Music
   Photography
   Shopping
   Travel
   Other
*Do you prefer a family with children?:    Yes
   No
   Not Important
*Do you prefer a family with animals?:    Yes
   No
   Not Important
*Do you smoke?:    Yes
   No
*Please indicate any medical conditions or allergies you have:
(If it doesn't apply, please write 'NONE')
  
What foods do you like?:   
What foods do you dislike?:   
What do you normally have for breakfast?:   
What do you normally have for lunch?:   
What do you normally have for dinner?:   

 

III. Fee Summary & Agreement
Note: Before you fill this section you must finish with parts I and II.

Registration:
  $  100.00    USD
*Tuition Fee:   
   X Months = $
*Home Stay Fee:    $ 200 USD X Months = $
Homestay Placement fee:
  $  50.00    USD
*Airport Pick-up:   
*Airport Drop-off:   
*Insurance    Months X $ 75 USD= $ USD
*Total Fees: $ USD                *
*Payment Method:

   Direct Deposit
   Check
   Bank Transfer

Comments:   
By submitting this form I agree to the following statements:

    


*I am 18 or older, and I agree with and affirm the foregoing Affirmation.

Make sure you have filled all required fields an calculated
your fees before submiting this form