Toll Free: 1 800-511-0179   |   Contact us

Online Application

Personal Information
First Name (as it is on your passport)
Last Name (as it is on your passport)
Email Please list only one, valid email address!
Birth Date (MM/DD/YYYY)
Language Level

See How to Rate Your Language Level


Address
City
USA State / Canadian Province
State/Province (Outside N. America)
Postal Code
Country
If the above address is temporary (College Campus, etc.) enter your permanent address below.
Alternate Address
City
USA State / Canadian Province
State/Province (Outside N. America)
Postal Code
Country

Home Phone
Work Phone
Cell Phone
Fax

Sex Female    Male
Occupation
Employer or School Attending
Nationality
Passport Number (If not available, provide ASAP)
Emergency Contact
Emergency Phone
Languages You Speak
List the name(s) of any especially
helpful AmeriSpan staff member(s)
How you heard about us
Program Type
Calendar Year in which
you wish to study
Type of Program




Teenager and High School Programs

You can apply for teen and high school programs by going to the Teen Application Form.

Group Programs

You can apply for group programs by going to the Group Program Form.





Language School Program Options
Select Country
Program Location
Course Description
Course Special Notes
Number of Weeks
Business & Professional Program Options
Select Country
Program Name
Course Description
Course Special Notes
Number of Weeks
Programs for Educators Options
Select Country
Program Name
Course Description
Course Special Notes
Number of Weeks
Language & Fun Program Options
Select Country
Program Name
Course Description
Course Special Notes
Number of Weeks
Volunteer/Internship Placement Options
Placement Type
Select Country
Placement First Choice
Placement Second Choice
Placement Third Choice
Placement Comments
# of Weeks of Language Class: If not taking classes enter 0 (zero)
Placement Length (Weeks):
Health/Physical Do you have any health related or physical conditions that would limit
where you could be placed? If yes, please explain.
Volunteer/Internship Essay Question You can do your essay questions now (recommended) but if you prefer, you can download this word document and complete your answers later and email, fax or upload them.
SALUD Medical Spanish Program Options
Country s
Program Name
Type of Studies Undergrad     Grad     MD     RN     DDS
Other:
Med School Years
Finished by Program Start
Specialty/Particular Interest
State your Expectations
(ex. improve medical vocabulary, learn about another culture, etc.)
What previous experience, if any, do you have with LEP (Limited English Proficiency) patients?
Were you effective in communicating with them and understanding them? Explain.
College Study Abroad Program Options
Program
Course Listings
Language Course(s)
Elective Course(s)
Current School/University
Year in School
Cumulative Grade Point Average
(on a 4.0 scale)
Dates & Lodging
School Start Date Calendar (MM/DD/YYYY)
School End Date Calendar (MM/DD/YYYY)
Placement Start Date Calendar (MM/DD/YYYY)
Placement End Date Calendar (MM/DD/YYYY)
Lodging
Type of Lodging

If AmeriSpan is providing your lodging, please provide the following information.
School Lodging Start Date Calendar (MM/DD/YYYY)
School Lodging End Date Calendar (MM/DD/YYYY)
Placement Lodging Start Date Calendar (MM/DD/YYYY)
Placement Lodging End Date Calendar (MM/DD/YYYY)
Are your traveling with a companion?
If so, what is their name?
Will they stay in the same lodging? No     Yes    
Same Room? No     Yes    
Same Bed? No     Yes    
Any other Comments


If you are choosing a Homestay as your lodging, please fill out the following.
Note that while we try our best with homestay requests, we cannot guarantee that any or all requests will be satisfied.
Please rank your requests in the order of importance.
Rank Request
Children Either     No     Yes    
Smokers Either     No     Yes    
Special Diet
Allergies
Other
Arrival Information
Do you want an airport pick-up No     Yes

Airport Pickup
If you wish an airport pick-up and you know your flight details, you may provide it now. In general, we recommend that you wait for AmeriSpan to confirm your program prior to purchasing a non-refundable airline ticket. You may submit your application without this information.

Airport Pickup Cost (See pricing table above)
Airport Pickup Airline
Airport Pickup Flight Number
Airport Pickup Date Calendar (MM/DD/YYYY)
Airport Pickup Time

No Pick-up but AmeriSpan is Arranging Lodging
If you will be staying in lodging arranged by AmeriSpan, we need an estimated time (a 2-3 hour window) when you will be arriving to that lodging so you will be expected. You may provide this information at a later date.

Arrival Time
Combine Programs
Do you want to register for another program/city program? No     Yes
Program Type
Type of Program




Teenager and High School Programs

You can apply for teen and high school programs by going to the Teen Application Form.

Group Programs

You can apply for group programs by going to the Group Program Form.





Language School Program Options
Select Country
Program Location
Course Description
Course Special Notes
Number of Weeks
Business & Professional Program Options
Select Country
Program Name
Course Description
Course Special Notes
Number of Weeks
Programs for Educators Options
Select Country
Program Name
Course Description
Course Special Notes
Number of Weeks
Language & Fun Program Options
Select Country
Program Name
Course Description
Course Special Notes
Number of Weeks
Volunteer/Internship Placement Options
Placement Type
Select Country
Placement First Choice
Placement Second Choice
Placement Third Choice
Placement Comments
# of Weeks of Language Class: If not taking classes enter 0 (zero)
Placement Length (Weeks):
Health/Physical Do you have any health related or physical conditions that would limit
where you could be placed? If yes, please explain.
Volunteer/Internship Essay Question You can do your essay questions now (recommended) but if you prefer, you can download this word document and complete your answers later and email, fax or upload them.
SALUD Medical Spanish Program Options
Country s
Program Name
Type of Studies Undergrad     Grad     MD     RN     DDS
Other:
Med School Years
Finished by Program Start
Specialty/Particular Interest
State your Expectations
(ex. improve medical vocabulary, learn about another culture, etc.)
What previous experience, if any, do you have with LEP (Limited English Proficiency) patients?
Were you effective in communicating with them and understanding them? Explain.
College Study Abroad Program Options
Program
Course Listings
Language Course(s)
Elective Course(s)
Current School/University
Year in School
Cumulative Grade Point Average
(on a 4.0 scale)
Dates & Lodging
School Start Date Calendar (MM/DD/YYYY)
School End Date Calendar (MM/DD/YYYY)
Placement Start Date Calendar (MM/DD/YYYY)
Placement End Date Calendar (MM/DD/YYYY)
Lodging
Type of Lodging

If AmeriSpan is providing your lodging, please provide the following information.
School Lodging Start Date Calendar (MM/DD/YYYY)
School Lodging End Date Calendar (MM/DD/YYYY)
Placement Lodging Start Date Calendar (MM/DD/YYYY)
Placement Lodging End Date Calendar (MM/DD/YYYY)
Are your traveling with a companion?
If so, what is their name?
Will they stay in the same lodging? No     Yes    
Same Room? No     Yes    
Same Bed? No     Yes    
Any other Comments
Price Information
Registration Fee (Do not include $ sign)
Program Cost (Do not include $ sign)
Late Fee (Do not include $ sign)
Other Costs (not listed above) Describe: (Do not include $ sign)
Total Deduction/Discount Code: (Do not include $ sign)
Total Price (Do not include $ sign)
Miscellaneous Information

Academic credit is not available for all programs.

Will receive Credit from Brookhaven College
Will receive Credit from
Other Program Options or comments
Terms & Conditions

I have read and agree to the terms and conditions.

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Email: info@amerispan.com
Business Hours: 8am-2pm EST (Mon-Thu), 7am-1pm EST (Fri)
Toll Free in USA & Canada: 1 800-511-0179
Worldwide: 1 (215) 531-7917
We offer programs in the following countries:
Argentina  Brazil  Canada  Chile  China  Colombia  Costa Rica  Dominican Republic  Ecuador  France  Germany  Greece  Guatemala  India  Italy  Japan  Jordan  Korea  Mexico  Panama  Peru  Poland  Portugal  Puerto Rico  Russia  Spain  Switzerland  Uruguay 

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