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Enrollment Form
Please provide the following contact information:
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Name
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| Title |
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| Organization |
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| Street Address |
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| Address (cont.) |
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| City |
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| State/Province |
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| Zip/Postal Code |
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| Country |
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| Work Phone |
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| Home Phone |
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| FAX |
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| E-mail |
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Have you ever taken Spanish before? |
Never
1 Semester in High School
1 Semester in College
2 Semesters in High School
2 Semesters in College
More |
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What is your current
Spanish Proficiency Level?
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= none, 5 = very good |
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Which language skills do you need to improve?
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1 = not very important, 5 = very important
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In which of the following situations do you need to use the language?
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1 = seldom, 5 = very often
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Please describe
yourself: |
Status: Student Professional Other
Sex:
Male
Female |
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How many total hours of Spanish Tutoring are you interested in? |
1
hour Trial Only
5 Hrs
10
Hrs
15 Hrs
20 Hrs
More
than 20 Hrs |
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How many hours per week of Spanish Tutoring are you interested in? |
1 Hr 2
Hrs 3 Hrs
4 Hrs
Online Training Live
Training (in person) in Richmond, VA
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When
you could have your sessions? Please check all that apply |
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Course Name:
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Comments
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Feel free to ask any question or doubt concerning Spanish programs.
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How did you hear about us |
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| Would you like to receive our newsletter? |
Yes No |
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