Gender: * Male  Female 

Street Address:

City State/Provice, Postal code:

Country:

Nationality (if differnt):

Date of birth:

Phone number:

E-mail address:

Profession / Ocupation:

Requested study start date (ex. 3 April 2005)

Planned weeks of study: 1 week  2 week  3 week  4 week  1 month  More then one month 

Language you will study: Spanish   Quiche / K'iche  Spanish on-line   Quiche / K'iche on-line 

Additional Activities / Optional: Spanish & Volunteer  Volunteer work only  lunteer work & Host family (No Spanish classes)  Salsa & Spanish 

time available and your (expected) Spanish level.

In case of the combination of Spanish classes and Salsa classes: please specify the style of interest and the amount of hours for Spanish classes.

Describe any previous experience with this language:

Describe any special areas of study on which you want to concentrate:

Describe any preferences concerning your family homestay; e.g. pets, children, smoking:

Describe any special dietary requirements:

Describe any allergies or medical conditions of concern:

Please provide emergency contact information. At a minimum, include name, telephone number, and relationship:

1.How did you find out about Celas Maya: Google  123Teachme  Xelapages   Other web site 

2. What can we do to make our website more informative/easier to use: