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Study Abroad & Leisure Travel Guadalajara, Mexico 2009 Application

Desired Program:
Spanish Immersion (more info)
English Literature (more info)
Spanish Immersion Options
Select one:
Leisure Travel
Note: certificate for 8.0 CEUs awarded; req. attendance at orientation in May at LSC-Montgomery
College Credit
Note: seeking college credit (4) & required to attend classes at LSC-Montgomery one week prior and week after the trip. Tuition payment req.
Check one box for SPAN 1411 (Spanish Beginning I) or SPAN 1412 (Spanish Beginning II)
Linked CE Class
Note: certificate 8.0 CEU's awarded & required to attend classes at LSC-Montgomery one week prior and week after the trip. Tuition payment req
CSPAN 3141101 (Spanish Beginning I)		CSPAN 3141201 (Spanish Beginning II)
Spanish Prerequisite
SPAN 1411 - semester/yr		SPAN 1412 - semester/yr
English Literature Options
Note: seeking college credit (3) & required to attend classes at LSC-Montgomery one week prior and week after the trip. Tuition payment req.
ENGL 1302 - Seeking college credit & required to attend class at LSC-Montgomery	ENGL 2442 - Seeking college credit & required to attend class at LSC-Montgomery
English Prerequisite
Select courses completed or currently enrolled in:
ENGL 1301 - semester/yr		ENGL ____ - semester/yr
Basic Information
Personal Information
Last name
First Name
Middle Initial
Student ID #
Passport #
Place of Birth
Date of Birth
Address
City
State
ZIP
Home Phone #
Cellphone #
E-mail address
Emergency Contact
Emergency Contact Phone
Academic Information
Home Institution:
If other, please specify...
Health Insurance
Note: Lone Star College provides a basic Health Insurance Program. Please list the name of your personal health insurance.
Insurance Company Name
Policy Number
Do you have any type of allergies?
Are you under medical treatment?
Prior Language Training & Travel
Spanish classes in Guadalajara are taught by Universidad Autónoma de Guadalajara professors. Upon arrival, a placement exam (oral and written) will determine the level (1-7) of your Spanish classes. It is recommended that participants arrive in Guadalajara with at least survival Spanish. Please check the LSC spring schedule for Spanish classes.
Have you traveled before?		Yes No
If so, where to?
Who referred you to the program?