Application Form 2016
Please remember to include 2 passport-size photos with your
name printed on the back.
Personal Information (PLEASE PRINT CLEARLY USING BLOCK LETTERS)
______________________________________________________________________________________________________________
First Name
Last Name
Student ID
Passport
photo 1
_________________________________________________________________________________________________________
Address
_________________________________________________________________________________________________________
City
State/County
Postal Code (ZIP)
__________________________________________________________________________________
Country
Nationality
_______________________________________________________________________________________________________________
Telephone
Email
Date of birth: __________________________
Passport number: ____________________________
Emergency contact info: _________________________________________________________________
Academic Information (PLEASE PRINT CLEARLY USING BLOCK LETTERS)
FOR STUDENTS ONLY
_______________________________________________________________________________________
Name of your most current Spanish professor at UH
His/her phone number and/or email address
_______________________________________________________________________________________
Number of years you’ve studied Spanish at the university
Level of Spanish you’ve most recently completed
______________________________________________________________________________________
GPA
Level of Spanish (please check one)
o Beginner. Fair understanding of basics; can speak in simple statements.
o Intermediate. Can write short sentences and participate in a basic conversation.
o Advanced. Can write complex sentences and participate in all conversations.
o Superior. Your Spanish – both in written and spoken contexts – is nearly like a native’s.
Accommodation Data (PLEASE PRINT CLEARLY USING BLOCK LETTERS)
FOR STUDENTS ONLY
___________________________________________
Please list here above any special dietary needs, such as ‘vegetarian’ or ‘food allergies’ (please specify).
___________________________________________
Do you have other allergies (cigarette smoke, pets, etc.)? Please specify here above.
___________________________________________
If you are taking any medication, please specify here above. Additional medical information?
___________________________________________
Normally students live in pairs or triples. If you would like to share a host-family room with a friend (same sex
only), please write his/her name here above.
Submit this form along with two passport-size photos and a copy of your
passport to the Hispanic Studies Department, Agnes Arnold 416.
Questions? Contact Dr. Liz Goodin-Mayeda cegoodin-mayeda@uh.edu
Passport
photo 2
Cadiz 2016 Summer Program
4 week program
*Extended application deadline: April 1, 2016
PRICING: $4500 Program fee
There are several scholarships for up to $1,750 offered by the office of Learning Abroad at UH
(International Education Fee Scholarship). For application, please check the following page:
http://www.uh.edu/learningabroad/scholarships/UHscholarships/IEFS/IEFS%20New%20Guidelines2.pdf
The airfare is not included. Students should make their own arrangements to arrive in Madrid by
Saturday June 4, 2016.
The Price includes:
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Overnight stay in Madrid on June 4th with a cultural visit in Madrid
Bus transportation to Cádiz on June 5th with a cultural visit to Córdoba on the way
Housing with a family, 3 meals included, laundry
Tapas welcome lunch
All class materials
University certificate
MundoLengua tutoring
Orientation walks
Torre Tavira visit
Flamenco and salsa lessons
Flamenco outing
Cooking class
Farewell dinner
Trip to Granada (Hotel and some meals included)
Tutorials
Bus transportation from Cádiz back to Madrid on Friday July 1st
Overnight stay in Madrid on July 1st
Tentative Itinerary
Friday June 3, 2016 - DEPART U.S. Students have the make their own arrangements to fly
into Madrid and be there on Saturday June 4, 2016.
As mentioned above, we will start our program in Madrid. Meeting point and hotel
information in Madrid will be available at the first Information Session during the last
week of March. We will have other information sessions during the semester.
Our program is from June 4 to July 2, 2016. Classes in Cádiz will run from June 6-June 30,
2016. We will go back to Madrid on Friday July 1 in the morning. Do not plan to depart
Madrid to any other destination before 3 pm on Saturday July 2.
Classes are Monday-Thursday 9:30-2:00pm.
COURSE OFFERINGS:
Students must fill out the study abroad equivalency form provided by the Office of Study
Abroad. I will provide assistance to students in this process.
Courses available for this program:
SPAN 2301 & SPAN 2302: Intermediate Spanish I /II
SPAN 2307 & SPAN 2308: Intermediate Spanish for Heritage Learners I/ II
SPAN 3301: Oral Communication in Spanish & SPAN 3302: Written Communication in
Spanish.
SPAN 3307: Public Speaking in Spanish & SPAN 3308: Written Comm. in Spanish for HS
Two 4000-level courses (Topics TBD depending on student needs)
Please list the 2 courses you are planning to take
1.
__________________________________________________________________________
2.________________________________________________________________________
Program Conditions
Payment Terms
General
Ø Once you submit your application form no later than March 23, 2016, you agree to pay
the full amount. The payment will appear in your UH bill. You have until March 23 to
withdraw your application without any penalty (see cancellation policy below). The
total program price is due preferably at the end of the program; however, if you need
more time, we may be able to give you an extension.
Ø We need a copy of your passport and two pictures.
Regarding Accommodation
Ø The student will be charged for the replacement of items broken due either to
negligence or intention on the part of the student.
Ø The student may be charged for the replacement of locks if the host family’s keys are
either lost or stolen due to negligence on the part of the student.
Regarding Expulsion
Ø In the case of a serious disciplinary offense, or infringement of one of the Program
Rules (see next page), MundoLengua reserves the right to expel the student from the
program (both school and accommodation components) without any refund of unused
portions and/or components of the program. The student will also be responsible for
any fees associated with the return to his/her home country.
Ø Students are also responsible for the cost of damages caused to third parties as a result
of student infringement of the Program Rules (see Program Rules, next page).
Regarding Cancellations
Ø If the student cancels after March 23 and before May 6, 2016, we will refund him/her
all monies paid less applicable transaction costs ($150.00).
Ø If the student cancels from May 7-June 3, 2016 we will refund him/her all monies paid
less $300 dollars.
Ø No refunds will be paid once the program has started.
Program Rules
1.
Students will respect and uphold family rules. Activities such as inviting guests to
the host family’s home, smoking inside the home, use of the family’s telephone,
and, if applicable, use of the family’s Internet, must be approved by the family.
2.
Students will not drive cars, motorcycles or scooters at any time during the program.
In order for a student to drive any off-road motorized vehicle, the student should
make a request to the director.
3.
Hitchhiking or soliciting a ride from a stranger is prohibited.
4.
Students must take responsibility for all personal property; MundoLengua cannot be
held responsible for any student’s personal property that is lost or stolen.
5.
Students will not discuss their host family’s private affairs with anyone other than a
MundoLengua representative.
6.
Students cannot change their host family without permission from a MundoLengua
representative and the UH director.
7.
Students must obey all local and national laws.
8.
Use of illegal drugs, or association with anyone involved with illegal drugs, will
result in the student being returned to his/her home country, without recourse and at
the student’s expense.
I certify that I have read, understood
and agree to the terms put forth in these
Program Conditions, as well as the
Program Rules which I must follow as a
participant in a MundoLengua/UH
program.
_____________________
Signature,
Release/Agreement
I agree that if I, ________________________________________________, become ill or have an
accident, MundoLengua or its representatives (including group coordinators, or accompanying
professors) may take such action as they consider necessary to secure medical treatment,
including the administration of an anaesthetic and surgery, always respecting the student
religious and medical observations and traditions.
Liability Release
I hereby release MundoLengua/UH, its officers, Board of Directors, representatives and agents
from any and all claims, charges, costs and/or causes of action – whether covered by insurance
or not - for loss of property, personal injury, illness, accident or death sustained by the
participant during the MundoLengua program.
Further Points
I understand that MundoLengua’s future publicity materials may include statements made by
participants or their photographs.
___________________________
Date
Misrepresentation Clause
If I have personally misrepresented, or have knowledge of misrepresentation of any portion of
this application, I understand and agree that MundoLengua has the option of immediately
dismissing the participant from the program, and sending the participant home. In the event
that I am sent home in such a case, I understand that I bear all the costs incurred and that the
program fees are non-refundable.
I, ____________________________________ student I.D.______________
authorize the Department of Hispanic Studies to bill me the amount of $4500
dollars related to the program cost for the Study Abroad in Cadiz, 2016 (it will be
billed on March 23, 2015, but you don’t have to pay the full amount until later).
You must also fill out all the forms required by the University of Houston’s Office of
Learning Abroad: 501 E Cullen Building, http://www.uh.edu/learningabroad/