Summer Language Culture Language Program Seville SPAIN The undersigned

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Summer Language Culture Language Program Seville SPAIN The undersigned Powered By Docstoc
					                   Summer Language & Culture / Language Program
                                                  Seville – SPAIN 2010

The undersigned is applying for ADELANTE’s Summer Language & Culture or Summer Language Program in Seville Spain and agrees to
abide by the standard terms and conditions as printed on the reverse side. (NOTE: Please attach Two Recent Passport-sized Photos,
Transcripts, Copy of Passport, Application Fee)
Date
Name
Address



Email

Social Security Number

Phone and Cell Phone Numbers

Birthdate                                                                  Nationality

Passport Number

College or University / Year Graduated (if applicable)

Field of studies / Major

Person to contact in case of emergency. Please list name, address and phone number:




Lodging will be Homestay with a Spanish family, and based upon availability. Meals and laundry included.


Do you smoke?           Special diet requirements?                                        Any allergies?
Do you mind if someone in the Homestay family smokes?


Have you traveled or studied abroad previously? Where and for how long:




How much Spanish study have you had? Please list courses you have taken:




List Course Selections
1.                                                        2.


University Transcripts needed? (Please circle one):            YES    NO

Spanish proficiency level:                            □    Beginner                       □    Intermediate

(For Office use only: Oral Test results)                                                  □    Advanced

Do you speak any other languages / what level?

ENROLLMENT FOR PROGRAM (Please circle)                 Summer 2009 price in effect             Spanish Language and Culture
                                                           for all Summer 2010
                                                                                                  May 31st – July 7th, 2010
                                                         applications received by
     Enrollment Deadline is April 19th, 2010                  June 1st, 2009.                            Cost: $3,595


                                         There is a $150US non-refundable Application Fee
GENERAL TERMS AND CONDITIONS AND INDEMNITY
                           In consideration of ADELANTE, LLC, by accepting me into ADELANTE’s Summer Language &
                           Culture Program in Seville, Spain, I hereby agree:
                           I acknowledge that international travel involves risk, including the possibility of illness, adverse
                           weather conditions, travel delays, strikes and other work stoppages, hostile actions by
                           governments or individuals, and other risks and inconveniences, whether or not similar. I
                           acknowledge that ADELANTE is not responsible for the activities of persons not employed by
                           ADELANTE. On behalf of myself and heirs and assigns, I fully and forever release ADELANTE and
                           its officers, directors, managers, members and employees, and agree not to seek compensation
                           from any of them, for any losses that I may suffer during my study abroad or during travel to and
                           from my intern / study abroad.
                           I will abide by the appropriate laws, rules and regulations of Spain throughout the time I am
                           participating in my intern / study abroad, and will endeavor to comply with all local customs.
                           I will participate in my intern / study abroad program, studying and learning in a Spanish
                           University, and fulfilling work assignments in a Spanish company, to the best of my abilities.
                           I will pay my way, to and from my home country and Spain.

                           I will indemnify ADELANTE and its officers, directors, managers, members and employees
                           against all loss or damage and any claims made against any of them as a result of any breach by
                           me of the undertakings and agreements set forth above, or any negligent actions or inactions by
                           me during the course of my participation in the intern / study abroad program. Program fees are
                           non-refundable if cancellation occurs within 45 days of program start date.
PERSONAL AND PROFESSIONAL REFERENCES

#1                         Name

                           Phone

                           Email

                           Relationship to you:

                           Length of relationship:


#2                         Name

                           Phone

                           Email

                           Relationship to you:

                           Length of relationship:

I represent that all of the above information is true and is given to induce my participation in the Summer Language & Culture Program in
Seville Spain. I authorize ADELANTE, LLC, to make such investigations as necessary, including contacting the above references.
I have read the terms and conditions stated above and agree to all of these terms and conditions.


Authorized signature:

Printed name:

Date:                      (For Office Use Only):

If Paying the Application Fee ($150 non-refundable) by credit card: VISA____ MC____ Exp Date_______
Name on Credit Card:_________________________ Credit Card Number:____________________________________
                                                 ADELANTE, LLC
                                     101 Main Street, Suite B, CA, 90740 - USA
                                            www.adelanteabroad.com
                                    Tel: (562) 799-9133 / Fax: (562) 684-4682