APPLICATION FORM
Name of Student :
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Birthdate or Age of student:
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Month
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Day
Year
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AM/PM Option
Sex
Please Select
Male
Female
E-mail:
*
Address:
City:
State:
Country
Zip Code
Phone:
*
Profession/Occupation:
Arrival & Knowledge Information
Date you will arrive in Guatemala City?
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Do you want pickup service in Guatemala City?
Please Select
Yes
Not
If yes: Which Airline? (leave blank if arriving by land)
Time of arrival in Guatemala City?
Date you will arrive in Xela? (mm/dd/yy)
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Month
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Day
Year
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Date you will start classes? (mm/dd/yy)
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Month
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Day
Year
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How many weeks will you study?
Spanish Level:
Please Select
Poor
Fair
Good
Excellent
Emergency Contact Information
In case of emergency contact
Contact Phone #s: Home & Work
Contact E-mail
IF YOU REQUEST A HOST FAMILY:
Special dietary or medical needs. (Vegetarian Meals, Food Allegies..etc.)
Comments Details or Requests
Submit
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