Name
Email:
Mailing Address:
Street 1 (Apt.No, etc.)
Street 2   
City:   
State/Province:   
Country:  Zip/Postal Code:

Dates you are considering for study abroad:
Would you like to stay with a Mexican family?   Yes       No
Have you studied Spanish before?      Yes       No
If yes, where (high school, university, etc.)? 
For how long? (semesters, etc.)  

How would you rate your proficiency in Spanish at the present time:
             Good     Fair       Poor       I am a beginner 

If you have studied Spanish before, please use the quizzes on the 
Platiquemos website, and let us know the results.  This will help the 
school place you at the most appropriate level. If you take a quiz for 
more than one level, please give us the results up to three quizzes.

Quiz Level:    Number of right answers: 
Quiz Level:    Number of right answers: 
Quiz Level:    Number of right answers: 

Any other information that would help the school respond to your 
interests and needs.  For example: Assistance in locating hotel or 
apartment lodging; special dietary requirements; smoking or no 
smoking environment; handicap access, etc.

If you have a pretty good idea which Level you'll be placed in at the school (for instance previous study at the school, you're an absolute beginner, etc.), it can be helpful to acquire the materials the school uses (Platiquemos) and get a head start.  After submitting this form, you can return to the Platiquemos website to order materials (don't forget to look for specials, which are usually at the top of the home page).

Whatever your decision, we thank you for your interest in Platiquemos and the Cuernavaca Language School, and wish you great success in learning Spanish!