Student Enrollment Form
Arizona Language Center
Class Information
For which class are you enrolling?
*
Select Class
ESL Group
ESL Private
Spanish Group
Spanish Private
TOEFL Preparation
IELTS Preparation
Interpreter Course
Have you completed the placement test?
Yes
No
What is your desired score / band score (ielts) ?
When is your desired class start date?
*
/
Month
/
Day
Year
Choose a date
When is your desired class end date?
/
Month
/
Day
Year
Choose a Date
Student Information
First Name
*
Last Name
*
Street Address
*
Apartment/Suite
City
*
State
*
Country
*
Zip Code
*
Main Phone
*
Cell Phone
Email
*
Date of Birth
*
Emergency Contact Person
First Name
Last Name
Emergency Contact Phone
Which language will you study?
How did you hear about us?
Friend
Google / Search
Facebook / Social
• A one-time Enrollment fee of $25.00 will accompany this form for group classes. I understand course fees must be paid in full before attending the first class and are nonrefundable. • In order to retain course fee credit for private classes, I agree to submit written notice via email at least 24 hours in advance to postpone or cancel a scheduled class. I understand that failure to do so will result in the private class fee being charged. Group class fees are non-refundable although schedules may change according to student enrollment and at the discretion of management. • I confirm that any cell phone calls or text messages will be answered outside the classroom only. • I will not hold Arizona Language Center responsible or liable for any event while attending classes. • For quality control, classes may be observed, photographed or recorded for promotional and/or teacher-training purposes. • By submitting this form, I agree I am over 18 years of age, in good health, and I understand the terms and conditions of this agreement.
SUBMIT
Should be Empty: