Application Form
		Surname:   First Name:   Date and place of birth:   Nationality:   Passport n°:   Profession:         Address:   Home Tel.:   Work Tel.:   Fax:   e-mail:
		Which languages have you studied? Knowledge of Italian: none poor standard good very good Have you completed the test and interview form in our website? Yes No If yes, what level did you attain? For how long do you plan to study Italian at Prolingua? Reasons of study: University/studies in Italy Work in Italy General culture Work abroad for It. Company Other (specify)
		Please indicate your Italian For Foreigners course of interest: Intensive short course Intensive long course Standard short course Standard long course No. of weeks: From: to (DD/MM/YYYY) Level: Beginners Elementary Pre-intermediate   Intermediate Upper-intermediate Advanced Are you inerested in the I + B option? Yes No Are you interested in ou specialized courses? Yes No if yes, which?
		I would like Prolingua to arrange my accomodation Preference: Shared Apartment ( single bedroom Double bedroom)   Autonomous Apartment Hotel Family home   Bed and Breakfast Please indicate the maximum price in Lire or Euro: I'm a ... Smoker Non smoker special needs or medical conditions:
		I paid my 150€ registration fee on: (DD/MM/YYYY) I also paid an additional 100€ deposit for housing Method used: cash Bank transfer Eurochèque   Credit Card Bancomat Italian checks   Please check the box to confirm that you have read and understood the general conditions exposed in this web site.