Taalstages DEPAUW

Reservation form

RESERVATION FORM


Code:	(*)
Undersigned:	(*)
Name:	(*)
First name:	(*)
Wish to have a residential stay for	(*)
From	to
Situated in:
Chosen language:	(*)

Student's details:

Name:	(*)
First name:	(*)
Street + number + box:	() ()
Postal code + location:	() ()
Telephone parents:	/
Parents mobile :	/
Email parents:	(*)
Email student:
Date of birth:	/ / (*)

School name:
Street + number + box:
Postal code + location:
Class:	(*)
Level in comparison with the class:

Language teacher's name:
In the primary school I'll have followed	years for the chosen language.
In the secondary school I'll have followed	years for the chosen language,
	hours a week.
Have you already attended lessons in this language?
Number of lessons attended in this language?
How did you learn about Depauw?
Which is your insurance company?

Other remarks:


	(*) Required fields

** I agree to the terms and conditions (see practical conditions / FAQ's)