UCLM GENERAL FOUNDATION: “ESPAÑOL EN TOLEDO”COURSES

Please fill out this application form as completely and clearly as possible and send it to ESTO, by one of the following means:
  • Post: Español en Toledo, Plaza de Padilla s/n, 45071 Toledo, Spain
  • Fax: (+34) 925 26 57 61
  • E-mail:
You must take into account that all the information about allergies, illnesses, etc. is compulsory and especially important, and that our program will not take responsibility for the consequences resulting from their omission.
PERSONAL INFORMATION
Surname / Given names
Name you prefer to be called / Birth date(dd/mm/yyyy) / Sex
Male Female
Home address / City
Province / Region / FederalState / Zip code / Nation
Passport number / Expiration date / E-mail address
Home phone number / Cell phone / Fax number
EDUCATION
Education level (university, high school, etc.) / Academic degree (major and/or minor)
University / Center / Level of Spanish
Basic / Lower intermediate / Upper intermediate / Advanced
PROGRAM OF INTEREST
Name of the program / Option of accommodation:(if different, please specifiy)
University residence(double room)
With a family
Independent
Dates of the program
Please indicate if you are only going to enroll in some of the subjects of the course, and which ones:
ADDITIONAL INFORMATION
Father’s name / Occupation / Phone / Cell phone / E-mail address
Mother’s name / Occupation / Phone / Cell phone / E-mail address
Spouse’s name / Occupation / Phone / Cell phone / E-mail address
Another contact person / Phone / Cell phone / E-mail address
Insurance company(where appropriate) / Insurance ID number (where appropriate)
Important: Do you have any medical conditions / special needs of which you would like the program directors to be aware (illnesses, allergies, diabetes, coeliac disease, etc.)?
Are you vegetarian? / Are there any kinds of food you have problems with?
Yes No
*Complete the following sections only if you have chosen to live with a family:*(The program will try to respect these preferences).
Do you smoke? / Do you mind smoke in the household?
Yes No / No Somewhat A lot
Do you like having pets in the house? / Would you enjoy being in a family with children younger than 11?
Yes No No preference / Yes No No preference
Do you have any deeply-held religious beliefs and practices? / Other observations
Hobbies and interests
Please give us any information about yourself and your personality which you feel might help us match you with a family (use back if necessary)
As established in Spanish Organic Law 15/1999 (December 13th), for the protection of personal information, the UCLM GENERAL FOUNDATION informs the user of the existence of a computer archive of stored personal information details, with the aim of maintaining and managing the relation with users, as well sending them pertinent informations related to the services offered. You are entitled to having access, rectifying, cancelling and opposing the appearance of personal information, by sending an e-mail toor by writing to Fundación General de la UCLM, calle Altagracia 50, 13071 Ciudad Real, attaching a copy of an ID card / passport.Forms can be found at (Spanish) / Signature

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