Escuela Mexicana: Online Signup Form

Escuela Mexicana, Guanajuato, Mexico << Back to Enroll/Contact

Registration Form

Personal Information (all fields marked in BLUE are required)

First Name:

Last Name:

Primary (native) Language:

Other languages you speak / write:

Country/Region:

If you said "Other" country, please specify:

Current Street Address:

City:

Zip Code/Postal Code:

State or Province: if in U.S./Canada
if in Mexico

If you said "Other" state, please specify:

Phone:

Fax:

E-MAIL ADDRESS:

Gender: Male      Female

Marital Status:

Birthdate:

Occupation:

Indicate your preferences for classes and housing below:

Arrival date (at housing):

Departure date:

Date you wish to begin classes:

Date of last class session:

Learning Level: Beginning    Intermediate    Advanced    Fluent

Class Types Desired: One-on-one Tutoring  (depends on availability)
Group classes  (all groups may have 2-5 students)

Classes Desired:
(check the ones you'd like) EM100: "Live" classes (go to stores, restaurants, hotels, banks, bus station, etc.)
EM101 Grammar
EM102 Conversation
EM103 History
EM104 Literature
EM105 Mexican Cooking
EM106 Dancing

Housing Preference: Escuela Mexicana Dormitory
Family HomeStay

Smoking Preference

Other Preferences & Needs: Will bring a car
Can't walk very far
Need child care
I have dietary restrictions/allergies (see below)

Dietary Restrictions / Allergies:

In case of emergency, please notify:

Roommate's name
(if you have one):

How did you hear about our school?

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	<< Back to Enroll/Contact
Registration Form

Personal Information (all fields marked in BLUE are required)
First Name:
Last Name:
Primary (native) Language:
Other languages you speak / write:
Country/Region:
If you said "Other" country, please specify:
Current Street Address:
City:
Zip Code/Postal Code:
State or Province:	if in U.S./Canada if in Mexico
If you said "Other" state, please specify:
Phone:
Fax:
E-MAIL ADDRESS:
Gender:	Male Female
Marital Status:
Birthdate:
Occupation:
Indicate your preferences for classes and housing below:
Arrival date (at housing):
Departure date:
Date you wish to begin classes:
Date of last class session:
Learning Level:	Beginning Intermediate Advanced Fluent
Class Types Desired:	One-on-one Tutoring (depends on availability) Group classes (all groups may have 2-5 students)
Classes Desired: (check the ones you'd like)	EM100: "Live" classes (go to stores, restaurants, hotels, banks, bus station, etc.) EM101 Grammar EM102 Conversation EM103 History EM104 Literature EM105 Mexican Cooking EM106 Dancing

Housing Preference:	Escuela Mexicana Dormitory Family HomeStay Smoking Preference
Other Preferences & Needs:	Will bring a car Can't walk very far Need child care I have dietary restrictions/allergies (see below)
Dietary Restrictions / Allergies:
In case of emergency, please notify:
Roommate's name (if you have one):
How did you hear about our school?