Mélida Anaya Montes Language School
SPANISH STUDENT APPLICATION FORM

RETURN THIS FORM TO US VIA E-MAIL. Please type or print neatly. Complete all sections. The information you provide in this application is necessary in order for us to provide you with better services during your stay in El Salvador. We will not share your information with anyone.

CIS encourage people of different races, sexual identities, gender, ages, cultures, nationalities, and special abilities to participate. ç

Basic Information

Name:
Date of birth:
Occupation:
Country:
Passport number:
Expiration date:

Address:
Telephone:
Fax:
Email:

Spanish School

2. Have you studied Spanish or other languages before? Please describe.

3. At what level do you consider your Spanish speaking skills? (bold or circle)
zero beginner intermediate advanced conversational fluent

4. Do you plan on participating in the afternoon political-cultural program? If so, what are your interests for this program?

Housing and Health

CIS will not share your medical information, except whereas necessary to provide accommodation or to aid in medical emergency.

1. What are your housing preferences? (bold or circle)
Host Family Guest House Shared Apartment Other: _______________

2. Do you need any of the following housing options? (bold or circle)
No cats No dogs Without children No stairs Other: _____________

3. What are your smoking preferences?
I smoke I don´t smoke I need a non-smoking household

4. Do you have any dietary restrictions? (check all that apply)
__ Diabetic
__ Vegetarian
__ Vegan
__ Lactose Intolerant
__Food allergy (specify):___________________
__Other (specify): ________________________

5. Do you have any allergies to medicine?
No Yes (specify):_______________________________________________

6. Do you have any health problems/restrictions? (incl. asthma, migraines, etc.)
No Yes (specify):_______________________________________________

a. If yes, in what way are you managing it? (i.e. inhaler, insulin, etc)
b. If yes, what additional accommodations can we provide to help?

7. Are you currently taking any medication?
No Yes (specify):_______________________________________________

Please briefly answer the following questions:

1. Do you have any special skills (technical, health care, teaching ESL, computers, etc.)?
2. Have you been active in community, international solidarity, or political organizations or parties? Please describe.
3. Have you traveled to Latin America or elsewhere? If so, where, when, and what did you do?
4. Why do you want to participate in this program? What do you hope to get out of the experience?
5. Please give us your views on Central American issues.

To Apply

Send this form to us by E-MAIL and send your US$25 application fee to:

Los Olivos CIS
P.O. Box 76
Westmont, IL 60559-0076
USA