LANGUAJE SCHOOL (EDI)
Pre-registration form for Juniors

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

ACADEMIC BACKGROUND
ACADEMIC LEVEL REACHED
ARE YOU CURRENTLY STUDYING?
WHAT ARE YOU STUYING?
WHERE ARE YOU STUYING?
HAVE YOU EVER STUDIED ENGLISH BEFORE?
WHERE?

INFORMATION ABOUT THE PARENTS
FATHER'S NAME
PLACE OF WORK
OCCUPATION
PAGER
TELEPHONE AT WORK
EXTENSION
CELLULAR'S PHONE
MOTHER'S NAME
PLACE OF WORK
OCCUPATION
PAGER
TELEPHONE AT WORK
EXTENSION
CELLULAR'S PHONE
Father's email
Mother's email

PERSON AUTHORIZED TO PICK UP THE STUDENT OR STUDENTS
NAME
HOW RELATED

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.

One hour a day Two 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.


Twice a week
Monday-Wednesday Tuesday-Thursday
8 - 10 A.M. 8 - 10 A.M.
10 - 12 A.M. 10 - 12 A.M.
6 - 8 P.M. 6 - 8 P.M.
8 - 10 P.M. 8 - 10 P.M.


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


PWhy did you choose to study at the Instituto Cultural Domínico Americano?
What do you expect to achieve during your stay at the Instituto Cultural Domínico-Americano?