ENROLLMENT FORM

PART 1: PERSONAL DETAILS Title:

First name:

Family name:

e-mail address

Nationality:

Mother tongue:

Profession / Study:

Date of Birth

Day:

Month:

Year:

Address

Street:

City:

Country:

Zip code:

Tel.1:

Tel.2:

Fax:

How did you hear about Scuola Leonardo da Vinci?

If you find us on Internet, please specify where:

If "others" or "via an agency", please specify:

Why did you chose Scuola Leonardo da Vinci?

PART 2: ITALIAN LANGUAGE COURSE

I wish to enroll at the school located in:

Please fill in one application form for each city of choice in case you want to enroll for different locations.

N.B.: You can book several courses. Please use the following 3 fields.

Course 1: I wish to enroll in the following course:

If you enroll for a "Professional Course",
please select the professional field:

Starting dates:

Day:

Month:

Year:

Number of weeks:

PART 2b: COURSE 2

Course 2 - I wish to enroll in the following course:

If you enroll for a "Professional Course",
please select the professional field:

Starting dates:

Day:

Month:

Year:

Number of weeks:

PART 2c: COURSE 3

Course 3 - I wish to enroll in the following course:

If you enroll for a "Professional Course", please select the professional field:

Starting dates:

Day:

Month:

Year:

Number of weeks:

PART 2d: ADDITIONAL COURSE

Would you like to enroll to additional courses:

Special request/observations:

PART 3: MY KNOWLEDGE OF ITALIAN LANGUAGE

Have you already studied Italian?

If 'Yes' please complete the following:

University/ School:

Address:

Zip code:

City:

Name of the Teacher:

Self evaluation: (A1/A2... = Ability level according to the assessment scale of the European Language Portfolio)

Are you interested in Italian Language Diploma examinations?

PART 4: ACCOMMODATION

I wish the school to provide for my accommodation:

If 'Yes' please complete the following:

Type of accomodation:

Room type:

If you chose Hotel, please specify:

If Others, please give details:

N.B.:
Lodging costs for family and apartment
accommodation have to be paid upon the arrival in Italy.

For all accomodations: We need your credit
card number as guarantee to make reservations

Do you smoke?

Do you have any allergies?

If yes, please give details:

Do you need a special diet?

If "Yes", please give details:

PART 4: TRANSFER

Do you need transfer?

If yes, please give details:

Arrival date, day:

Arrival date, Month:

Arrival date, Year:

Arrival Time:

Arrival Location:

Flight Number:

Train Number:

Special requests / observations:

PARTE 5: PAYMENT

Note that if you are registering more than 21 days before the beginning of the course, we require the payment of the registration fee of 70 Euro. If you prefer, you can also pay the total course fees at once.

Note that if you are registering less than 21 days before the beginning of the course, we require the payment for the total course fees.

PARTE 5: PAYMENT

I will pay Euro

through:

If you chose online credit card or fax, specify credit card type:

If you chose online credit card please specify:

Credit card number:

Verification Number:

Expiring Date, Month:

Expiring Date, Year:

Card's holder Name and Surname (exactly as appears on the Credit Card)

If you chose credit card for fax, for security reasons, please fill in the appropriate form with your credit card details (* and, in the case of Amexco, also the additional number), and fax it to the following number of our registration centre: +39 - 055.290.396

PART 6: TO SEND ENROLLMENT My registration implies the acceptance of the General Conditions of Participation as mentioned in the Scuola Leonardo da Vinci web site and brochure.
Place:

Date:

PART 7: PRIVACY
Consent in accordance with Art. 23 of D. Lgs. 196/2003. The person concerned, having received the information furnished by the data processing owner in accordance with Article 13 of D.Lgs. 196/2003, hereby consents to the processing of his/her personal data for the purposes indicated in the aforesaid informative note. He/she also consents to the communication of his/her personal data for the purposes and to the subjects indicated in the informative note.
I herewith confirm my enrollment at Scuola Leonardo da Vinci I don't accept to send my details

To send the enrollment is obligatory to accept

Study Abroad in Italy - www.scuolaleonardo.com

ITALIAN LANGUAGE SCHOOL "Scuola Leonardo da Vinci"

Learn Italian in Italy in Florence - Milan - Rome - Siena

Officially authorised by the Italian Ministry of Education

ENROLLMENT FORM

ITALIAN LANGUAGE SCHOOL "Scuola Leonardo da Vinci"

Learn Italian in Italy in Florence - Milan - Rome - Siena