esl registration spr12

							SPRING Q U A R T E R 2 0 1 2
COURSE REGISTRATION FORM
ENGLISH AS A SECOND LANGUAGE

(PLEASE PRINT CLEARL Y)

Last (Family) Name

                                                                                                          INTE GRATED SKILLS
First (Given) Name                                                                                        Basic
                                                                                                          Course: $300/Session; $50 Materials fee
What country are you from?                                                                                   Session I: April 3 – April 26
                                                                                                            Session II: May 1 – May 24
Local Address                                                                                             Advanced
                                                                                                          Course: $300/Session; $50 Materials fee
                                                                                                             Session I: April 3 – April 26
City / State / Zip Code
                                                                                                            Session II: May 1 – May 24

Telephone Number                                                                                          CONVERSATION SKILLS
                                                                                                          Speaking and Listening
Email Address                                                                                             Course $300/Session; Materials $50
                                                                                                             Session I: April 3 – April 26
Gender        Male        Female                                                                            Session II: May 1 – May 24

How did you hear about our program?
                                                                                                          Focus on Accent Reduction
                                                                                                          Course $300/Session; Materials $50
   U of C Website             Friends            Family             Other                                   Course: April 3 – May 24


Are you a registered student at the University of Chicago?            Yes       No
Division or department                                                Student ID#

Will your department be sponsoring you?           Yes        No
Name of department contact

Email address of department contact

              Written confirmation from your department is required at the time of enrollment..

R E G I S T R A T I O N Please bring this form with payment to the Front Desk located on the first
                        floor of International House. Cash, personal checks, traveler’s checks,
                        Visa, and MasterCard are accepted.

F RONT DESK               Open each day from 7:00 am to 11:00 pm.

R EFUNDS                  There is no reduction in tuition for late registration. Prorated refunds will
                          be given only to students who withdraw on or before April 6th. An
                          administrative fee of $25 is assessed on all withdrawals. The fee for
                                                                                                                                   International House at
                          materials is non-refundable. No refunds will be given after April 6th.
                          Tuition fees cannot be transferred to the tutoring program.
                                                                                                                                The University of Chicago
                                                                                                                                    1414 East 59th Street
O FFICE USE ONLY                                                                                                                   Chicago, Illinois 60637
Amount Paid                                           Type of Payment
                                                                                                                                    Phone: 773-753-2281
Recorded by                                           Date                                                                             Fax: 773-753-1227
                                                                                                                              http://ihouse.uchicago.edu
Receipt Number                                                                                                           i-house-programs@uchicago.edu