Application Form

Please choose the Program | Por favor, elige el Programa *

Please choose the term | Por favor, elige el período *

Spring Term

Summer Term

Fall Term

Dates:
§ SPRING SEMESTER: January to April
§ FALL SEMESTER: August to December

Información General | General Information

Upload a portrait photo *

Maximum file size: 10.49MB

Upload a copy of your passport *

Maximum file size: 10.49MB

Upload your test level (done)

Maximum file size: 10.49MB

Surname | Apellidos *

Name | Nombre *

Birthdate | Fecha de Nacimiento *

Citizenship | Nacionalidad

Passport number | Núm. de pasaporte

Gender | Género

Female

Male

Other

Current address | Dirección actual

Permanent address | Dirección permanente *

Phone | Teléfono *

E-mail | Correo electrónico *

Academic Information | Información Académica

Current Studies

Institution | Centro de Estudios *

Date | Fecha

Major | Carrera *

Class of | Año

GPA

Name of Department Chairperson | Nombre de Jefe de Departamento *

Department Chairperson’s Mailing Address | Dirección de Jefe de Departamento

Chairperson’s Tel. | Tel. del Jefe de Departamento

E-mail | Correo Electrónico

College Registrar | Encargado de los Certificados de estudio en Secretaría *

Registrar's Address | Dirección de la secretaría

Registrar’s Tel. | Tel. de la secretaría

E-mail | Correo Electrónico

Electives | Monográficos

Please indicate the electives you wish to study | por favor, indica los monográficos que quieres estudiar

Courses Currently Enrrolled in | Clases actuales

Language Proficiency in Spanish | Dominio del idioma español

Reading | Lectura

Excellent

Good

Fair

Poor

Writing | Escritura

Excellent

Good

Fair

Poor

Speaking | Conversación

Excellent

Good

Fair

Poor

Understanding | Comprensión

Excellent

Good

Fair

Poor

Housing Preferences | Preferencias de alojamiento

IMPORTANT:

You will be living with a señora, frequently single, though not always. If single, she is likely to be divorced or a widow. Some of the host families include young children, older children, or no children at all; some have pets, while others do not; some host just one student, and others host several. Many families would like you to integrate into family life, while others accept you more as a boarder, but still as a member of the household.

Please respond honestly to the following items. Every effort will be made to meet as many of your preferences as possible, but please understand that not all preferences can be met. Your adjustment to this new experience will involve some changes of habit and/or diet. Try to remember that a student who is flexible stands a better chance of being content in the homestay.

Lenght of stay | Duración de la estadía

From

1. I prefer living with a "family":

with other students from my school

with non-American students

with other American students

where I am the only foreign student in the home

2. I prefer living with:

Pets

With pets

Without pets

No preference

Smokers

With smokers

Without smokers

No preference

Children

With children

Without children

No preference

3. If you would like to live with children, which do you prefer?

Young

Teenager

Older

No preference

4. Do you have any dietary restrictions (vegetarian, allergies to certain foods, etc.)?

Yes

If you answered yes, please explain:

5. Do you have any allergies or handicaps that we should take into consideration?

Yes

If you answered yes, please explain:

6. Do you have any siblings?

Yes

Brothers

Sisters

7. Have you traveled abroad previously?

Yes

If you answered yes, please explain when, where, and for what reason:

8. Where have you lived most of your life?

City

Rural Area

State

9. Please describe yourself. What type of a person are you? Independent, sociable, etc.

10. Please describe yourself in terms of your hobbies, likes and dislikes

11. Describe what you typically do from Monday to Sunday.

12. Describe what you expect to get out of your homestay.

13. Any additional information you would like us to know about you?

14. Objectives and motivation statement

15. Health

Medical history and insurance information

Maximum file size: 10.49MB

Please attach a medical history form – both physical and mental

Medical Emergency Contact Form

“I certify that I am in good physical and mental health and that I do not suffer from any mental or physical condition that would prevent me from successfully taking part in the study abroad program at
Tandem International School in Madrid Spain.

I further understand and agree that, in the event of an emergency abroad, we reserve the right to notify my parent(s) or guardian(s) as listed by me as ‘Emergency Contact Person (s) on this form.”

Emergency Contact Person (s)

Emergency Contact name *

Emergency Phone Number *

Emergency E-Mail Address *

Emergency Fax Number

Emergency Address

Certificate of Insurance

(Health, Accident, Medical, Hospital)

All program participants MUST be insured. This is for your own protection. If you do no currently have insurance, you must purchase, you must purchase adequate coverage beyond that provided by the International Student Identity Card (ISIC). Inexpensive insurance plans are available on a short-term basis.

You are required to have medical insurance for your entire time abroad. Be aware that most insurance policies in the U.S. are of the refundable variety; that is, you pay the doctor and /or hospital oversees, save the receipts, and return these to your insurance company for reimbursement. Please insure that you have extra cash on hand or a credit card for medical emergencies. If possible, take along your insurance company’s claim forms. Consider some supplementary emergency medical coverage if your insurance policy does not include medical evacuation and repatriation benefits.

My insurance Carrier has certified to me that the following polity, which is currently in force, will cover me while out of the country.

Insurance Company

Policy Number

Phone (International)

Valid through (Date)

Insurance company address

Insurance Policy Acceptance *

I understand that I am responsible for obtaining health, accident, medical and hospital insurance coverage for the entire period I will be a participant in the study abroad program for which I have been accepted. I also understand, and agree, that I will be responsible for paying up-front any medical bills I incur while I am abroad.

TANDEM Housing Contract

American University Programs

1. This contract is a binding commitment to live in the program housing assigned for the entire term. The program reserves the right to change the housing assignment under exceptional circumstances.

2. If there were a problem with the housing, the student should consult with the Program Director.

3. Students can expect the following from their host mothers, señoras:

a. 3 meals a day for full-board housing, or breakfast and dinner for half-board housing.
b. Clean living quarters.
c. Laundry service once a week.
d. Permission to receive short important phone calls on the house phone.

4. The student is not to do the following in his or her señora’s house:
a. Make phone calls on the house telephone.
b. Use or possess illegal drugs in the home.

TANDEM and Europa Plus intend to provide a residential atmosphere where study and learning can take place. This atmosphere is dependent upon the willingness of all who live in the house. Apart from these fundamental rules, each señora has the right the increase the rules of her house and to express clearly what she considers proper in her own home. The student is to respect the wishes and the rules of the house in which he or she lives.

The student acknowledges the need for socially responsible behaviour and recognizes the role of the Program Director in promoting such behaviour.

By signing this agreement, the student confirms his /her responsibility to accept the HOUSING CONTRACT.

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Step 2 of 2: Application Form

Información General | General Information

Academic Information | Información Académica

Current Studies

Language Proficiency in Spanish | Dominio del idioma español

Housing Preferences | Preferencias de alojamiento

Lenght of stay | Duración de la estadía

Medical Emergency Contact Form

Certificate of Insurance

TANDEM Housing Contract