Completed application form

Personal Details
Family Name:
First Name(s):
Home Address:
Telephone:
Date of Birth:
Email:
ID/ Passport No.
Nationality:
Emergency Contact Details
Family Name:
First Name(s):
Relationship:
Telephone:
How did you hear about us?
Former AIL Madrid Student
Search Engine:
Advertisement (please specify): __________________________
Agent (please specify): _________________________________
Google
Yahoo
Other (please specify): ____________________
Other (please specify): _________________________________
Start date: Monday ___ of __________ 201_
Extra weeks of Spanish study (minimum 4 weeks): ________
Please confirm that you meet the following criteria:
I am between 17 and 25 years of age:
I am an EU National, or from one of the specified countries on the Work Placement Website :
I have attached a copy of my CV
I already possess an intermediate knowledge of Spanish
I am able to commit to an eight week work placement after 4 weeks Intensive Spanish
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Education
Highest Level of Studies:
Relevant Academic Qualifications:
Languages Spoken (and level):
Previous Work Experience ( p lease mention any detail which may be relevant to your application ) :
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Work Placement Preferences ( I ndicate the sector you would like to work in ( e.g. Leisure and tourism, finance & banking ) :
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Academia Internacional de Lenguas Madrid S.L - C.I.F. B84717180
Inscrita en el Registro Mercantil de Madrid, Tomo 22.813, Libro 0, Folio 11, Sección 8ª y Hoja número M-408343
Work Placement - Enrolment Form ( Page 2 )
Fees
Accommodation
Price per week per week
Minimum stay (weeks)
Additional nights
Single room Double room
Spanish Host Family
1
196 €
170 €
x ______ weeks
28 € x ______ nights
Shared Flat
1
140 €
110 €
x ______ weeks
20 € x ______ nights
Student Residence
1
Total
(€)
From 230€ - Please consult for further details
Hotel - Please contact AIL Madrid to discuss your requirements
Course
4 week Intensive Spanish plus 8 week work placement
1295
Please indicate if you would like extra weeks of Intensive Spanish: 170 € x ______ weeks
Other services
Madrid airport pickup
Arrival only - 75 €
Medical Insurance:
Yes
Arrival and departure - 125 €
No
Total fees
Payment of Deposit
A deposit of 1000€ is required to confirm your enrolment.
For security reasons, please note that we do not accept cash payment by post.
Debit/Credit Card
Please either call or email ([email protected]) with the following details: 16 digit card number, expiry date, and 3 digit security code.
International bank transfer:
Bank name:
Banco de Sabadell S.A.
Address: Núñez de Balboa 20, 28001 Madrid, España
Account holder: Academia Internacional de Lenguas Madrid S.L
SWIFT/BIC Code: BSAB ESBB
IBAN (International Bank Account Number): ES79 0081 5077 7000 0142 2545
Confirmation
I have read and accepted AIL Madrid’s terms and conditions.
Signature:
Date:
Academia Internacional de Lenguas Madrid S.L - C.I.F. B84717180
Inscrita en el Registro Mercantil de Madrid, Tomo 22.813, Libro 0, Folio 11, Sección 8ª y Hoja número M-408343