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Mail application to:

Dr. Josť R. Reyna
Department of Modern Languages and Literatures
California State University, Bakersfield
9001 Stockdale Highway
Bakersfield, CA 93311-1099
(661) 664-2358

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APPLICATION

MORELIA SUMMER PROGRAM

2002

June 17 - July 5

NAME: _____________________________________________

SSN:___________________________________

ADDRESS: ______________________________________

Phone ( ___)____________________   E-Mail Address:_____________________________

Street/ City/ Zip___________________________________

OCCUPATION:_________________________________

Student (school/level)__________________________

Other:_________________________________

Highest level Spanish course taken ___________________________________

Housing Placement Information:  Sex: M_____ F_____

AGE BRACKET: 20-30___30-40___50+___ (for housing placement purposes)

Special Health Needs:__________________________________________________

Special Housing Needs (dietary, etc. All homes are non-smoking):_________________________________________

Special Educational Needs:______________________________________________

Other:___________________________________________________

Program Fee ($500.00) covers housing, meals (with family); instructional program; administrative fees; building use fee; textbook; tutoring; local walking tours. Not included: Extended University credit fee ($40.00 per quarter unit); travel to and from Morelia; excursions; insurance, medical/dental/personal expenses. Health insurance at extremely reasonable rate available through International Programs Office CSUB.

DISCLAIMER

I UNDERSTAND THAT THE MORELIA SUMMER PROGRAMS, CSUB, CSU OR THEIR PERSONNEL ARE NOT RESPONSIBLE FOR MY HEALTH, SAFETY, OR PROPERTY.

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SIGNATURE / DATE

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