General Information
REGISTRATION FORM:

First Name:

Middle Name:

Last Name:

Country:

State (Province):

Zip:

City:

Mailing Adress:

Date of birth:

Telephone:

Fax:

Email:

Place of birth:

Nationality:

Gender: Male Female

Where are you currently enrolled?

Graduated Undergraduated



INDICATE SITE YOU WILL ATTEND:


Guadalajara
Puerto Vallarta




INDICATE SESSION (S) YOU WILL ATTEND:

Consult the CECM calendar

2 week Intensive Program / 5 hrs. Per day – Monday to Friday.

Dates to

4 week Semi-Intensive Program / 2.5 hrs. Per day- Monday to Friday.

Dates to

5 week Summer Program / 5 hrs. Per day -Monday to Thursday.

Dates to

5 week Summer Program / 2.5 hrs. Per day -Monday to Thursday.

Dates to

Online Program - during 8 weeks.

Dates to

Spanish course for tourists / Two hours per day during one - week.

Dates to

One to One private instruction / Hours per day

Dates to

Other: / Hours per day:

Dates to

Will you study to earn credits? Yes No

INFORMATION FOR HOUSING PLACEMENT:

I want to lodge in with a Mexican family:
Private Room Shared Room

Pick up Service: Yes No

I prefer a host family:

With Children Without Children No preference
With Pets Without Pets No preference
Smoking Non Smoking No preference

Special Request:


I do not require lodging, I will arrange housing on my own.

Contact in case of emergency:


International Insurance coverage information:


If you have any medical condition please explain:


Type of blood:

PAYMENT METHOD:

Registration fee: 120.00 USD (2012) 125.00 USD (2013)

VISA Mastercard

Name of cardholder:

Credit Card Number: - - -

Expiration Date: /

CVV or CVC:



- Consult the CECM calendar and fees to select sessions you want to attend.
- CECM will charge only the registration fee. Please take note that this fee is Non-refundable. You will be expected to complete payment for all CECM services upon arrival.
NOTE: The Colegio de Español y Cultura Mexicana can only accept Mexican Pesos upon Arrival (to make the complementary payment for the course). The exchange rate will be taken from the US Dollar sale published rate by Santander Mexico on the day of the payment.
Admissions remains open until the start of each session.
- A PDF version of the form is available for those who do not wish to apply online You may also choose to mail the fee to the admissions office, but we cannot process your file until the fee has arrived.
- You will receive an official email notification of acceptance two to three days after CECM had received your application and registration payment.