Costa Rican Culture and Language Institute - ICLC - The Place where you can learn spanish abroad in Costa Rica
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ICLC

Adjunct Faculty Members or Coordinators
Information Form

Section A.  Personal & Contact Information

Last Name   First Name  
Gender   Passport Number  
Occupation        
Name of College
or University		  
Date of birth   Age  
Marital Status        
Telephone
(Country Code
+ Area Code + Number)		        
Address   City  
State   Country  
Zip Code        
E-Mail Address  
Spanish Level Information  

Section B.  Emergency Contact Information

Name, address, and telephone number of person to contact in case of an emergency:

Name

  

Address

(Please enter the address, city and ZipCode in one single line)

 

Telephone (Country Code + Area Code + Number)

  

 

Section C.  Flight Information

Flight Arrival Information

 Date of arrival  
  Airline  
  Flight Number  
  Time  
       

Departure Information

 Departure Date  
  Departure Time  

Section D.  Preferences Information

     

For more details in your answer,
use the text box
1. Do you smoke?  
2. Do you like pets?  
3. Would you like a family with children?  
4. Do you have any dietary requirements?  
5. Do you suffer from any types of allergies?  
6. Do you have special interests, activities or hobbies?  
7. Do you have any physical or emotional disability we should take into consideration in choosing an appropriate host family for you?  
8. Are you traveling with a companion?  
9. If the answer to question 8 is yes, would you like you and your companion to be placed with the same host family?  
10. If not in the same house, would you like to be in the same neighborhood with your companion?  
11. If you feel there is anything else we should know in order to best place you with a compatible host family, please indicate.  

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For questions or information regarding the new family homestay, please contact:
Instituto de Cultura y Lengua Costarricense
P.O. Box 609-4050
Alajuela, Costa Rica
Phone: +506 2-458-8485   Fax: +506 2-458-8473
 Contact link form.

Last Update:  2009-12-23

     
 
 
 
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