Tampa Language Center

Personal information

First Name*:

Last name*:

Middle Name*:

Address:

Street*:

City*:

Province/State*:

Country*:

Postal Code/Zip*:

Telephones:

am*:

pm*:

fax*:

E-mail*:

Occupation*:

Gender*

Male Female

Date of Birth

Day*:

Month*:

Year*:

Native Language*:

Program Choice

Target Language*:

Check all the sessions (8 wks or 12 wks) that you plan to study below (if more then one please indicate which quarter you would like to start)

1st quarter Jan, Feb, Mar

2nd quarter Apr, May, Jun

3rd quarter July, Aug, Sep

4th quarter Oct, Nov, Dec

Start date (month/day/year)*:

End date (month/day/year)*:

Small group Package:

$236.00 per student 16 hours of instruction $176.00 Registration fee & Materials $60.00 Placement test (Optional) $25.00

Semi Private Package:

($316.00 per student 16 hours of instruction $256.00 Registration fee & Materials $60.00 Placement test (Optional) $25.00

Private Package:

(Private classes can also be arranged on an as-needed basis)$476.00 per student 16 hours of instruction $416.00 Registration fee & Materials $60.00 Placement test (Optional) $25.00

*Private class package requires the contract section of the application form to be signed.

Contract for Private Classes- please review carefully

Student's name*:

I have arranged for private classes between (Day Month Year)*:

and*:

The class will meet on*:

Tuition for private classes is paid in advance,*:

week(s)

INCONVENIENCE COMPENSATION CLASS CHANGE POLICY

All classes are scheduled per above. If the student wishes to change any of the scheduled classes, the Language school shall be notified at either by telephone, (813-932-0482), email or fax (813-980-3751) at least 24 hours (one full day) in advance of the scheduled class. Any changes made less than 24 hours notice will be considered Ќlate cancellationЋ and the student will be charged in full for the class.

COURSE CANCELLATION POLICY

If the student cancels a course less then 1 week prior to course start date or after course has begun, 2 days of scheduled instruction shall be charged, plus a $25 administrative fee.

Please sign and date below to indicate your acceptance of the terms of this agreement