ENGLISH SCHOOL (EDI)
 Pre-registration form for Adults

PERSONAL INFORMATION
FAMILY NAMES
NAME
DATE OF BIRTH
GENDER F. M.
CEDULA OR PASSPORT
NATIONALITY
PLACE OF BIRTH
ADDRESS
NEIGHBORHOOD
TOWNSHIP
CITY
TELEPHONE NUMBER
BEEPER
CELULAR
EMAIL

PRESENT EMPLOYMENT
DO YOU WORK?
PLACE OF WORK
OCCUPATION
TELEPHONE NUMBER
EXTENSION
FAX
 
ACADEMIC BACKGROUND
ACADEMIC LEVEL REACHED
ARE YOU CURRENTLY STUDYING?
WHAT ARE YOU STUYING?
WHERE ARE YOU STUYING?
HAVE YOU EVER STUDIED ENGLISH BEFORE?
WHERE?

IN CASE OF EMERGENGY, PLEASE CALL
NAME
TELEPHONE
NAME OF STUDENT'S PHYSICIAN
HIS/HER TELEPHONE
 
 
MEDICAL HISTORY
PLEASE SPECIFY IF YOU SUFFER FROM ANY DISEASE, AND IF SO, WHAT
ARE YOU ALLERGIC TO ANY MEDICINE? TO WHAT?

WHY DID YOU CHOOSE TO STUDY AT THE INSTITUTO CULTUAL DOMINICO AMERICANO?
 Its teaching method
The quality of the teaching
The flexibility of its class hours
It's easy access
It's cost, compared to other languaje institutes
If others, what?

¿WHAT DO YOU EXPECT TO ACHIEVE DURING YOUR STAY AT THE INSTITUTO
CULTURAL DOMINICO AMERICANO?
To learn the languaje
To better my conversation
To better my grammar
To better my writing skills
To understang the languaje better

CHOOSE THE SCHEDULE OF YOUR PREFERENCE.
PLEASE MARK ONLY ONE SCHEDULE.

1 Hour a Day 2 Hours a Day
8 - 9 A.M. 8 - 10 A.M.
5 - 6 P.M. 10 - 12 A.M.
  6 - 8 P.M.
  8 - 10 P.M.

Once a week
Fridays 6 - 10 P.M.
Saturday 2 - 6 P.M.
Other