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Enrolment Form
My personal data
Name Last Name
Age Sex
Profession Mother tongue
Nationality Address
City Country
Phone Cell phone
Fax Email
I have known Europass through

My knowledge of Italian
Are you a beginner? Yes No Have you already studied Italian? Yes No
Where? How long?

I would like to enrol in the following course
ITALIAN LANGUAGE
Group course
From: To: Weeks:
Long Term course
From: To: Weeks:
Combined course
From: To: Weeks:
Private course
From: To: Weeks:
Exam Preparation course
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Language for Profession course
From: To: Weeks:
Summer School
From: To: Weeks:
CULTURE & ART
Italian language & Culture
From: To: Weeks:
From: To: Weeks:
From: To: Weeks:
From: To: Weeks:
Italian language & Jewellery
From: To: Weeks:
Italian language & Design
From: To: Weeks:
SENIOR (50+) AREA INSEGNANTI
From: To:
Weeks: 		From: To:
Weeks:
SPECIAL OFFERS SERVICES
Special offers Services
From: To:
Weeks: 		From: To:
Weeks:

Test Online
I have filled in
I will fill in the online placement test

I benefit from the following reduction
Full Scholarship Partial scholarship Group discount
'Au Pair' discount Other Specify

I would like to book the following lodging
Family
Shared apartment
Independent apartment
Hotel
Smoker? Yes No Allergies? Yes No
Which ones?
Are you vegetarian? Yes No Do you need ground transportation when you arrive? Yes No
Special Requests and other comments

Receipt of the DEPOSIT of 159* Euro
I have paid
I will pay in a week 159 Euro* for
International postal order
Banker’s draft (check)
Bank Account Wire Transfer In Favor of EUROPASS, Centro Studi Europeo:
Banca Nazionale del Lavoro, Via Verdi 16, 50122 Firenze
Codice Swift - BNLIITRR
IBAN IT05 P010 0502 9700 0000 0002 034
Conto corrente n. 2034, Agenzia 4
(please mark: no charges for the beneficiary)
I have sent the receipt
I will send the receipt
By mail By email By fax
* includes enrolment fee of 59 Euro and deposite of 100 Euro

Regulations and privacy
I have read and accept the regulations of EUROPASS, Centro Studi Europeo:
Consent for release of personal information
With respect to the present request for information and in accordance with law n° 196/2003 and, in particular, with the rights granted by article 7 of the same law, I consent to the use of my personal information, including the communication (and/or distribution) of my personal information by EUROPASS for the reasons granted by, and within the limits established by, the aforementioned law..
I agree | I disagree

 
 

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Copyright © 2008 EUROPASS - Italian Language School - Florence

Europass - Italian Language Courses
Via S. Egidio, 12 - 50122 Florence (Italy)
Tel. +39 0552345802 - Fax +39 0552479995 - Email europass@europass.it
P. IVA 04393630480