De Rada Italian Institute, Inc.
37
Kingston Hill Ct., Kingston, RI 02881 USA
Calabria 2012 Summer Language Program
Admission Application Form
(Deadline: April 15, 2012
– late applications may be considered)
Personal Data: First
Name ________________Middle____________ Last________________
Permanent Home
Address________________________________________________________
__________________________________________________
Permanent Home Telephone
___________________________ Fax #___________________
Mailing Address (if different)
_____________________________________________________________________________
Telephone at Mailing Address ___________________ Cell
phone ________________________
Email ___________________Date of
Birth__________________Citizenship ________________
Person to be contact
in case of an emergency: Name ______________________ Relationship
____________________ Phone _____________________ email
__________________________
Education/Employment
Data: Current School or Place of Employment and
Position _________
____________________________________ College Degrees
and Date Received_____________
___________________________ Previous Italian Language
Experience ____________________
__________________________ Other Language Experience
_____________________________
2012 Program 4-week Session (please check preference):
San Demetrio Corone, Calabria: June 23-July 20 ______
For other choices, please specify the dates you plan
to attend: ____________________
Course Options: Please check our course list on our website www.derada.com, and write down the course
number, title and number of credits:
________________________________________________________________________
________________________________________________________________________
Tutoring: 20 hours of private
tutoring in English, Spanish, French, Latin, Albanian, Romanian, Ancient Greek
Language and Literature, History, Philosophy, Anthropology, Religion, are also
available for an additional payment of $620.
Choice:_______________________________________________________________________
Tuition, Room and Board
(please check preference):
|
Program
Type |
Shared
Room |
Single
Room |
|
1-week |
$1,300 |
$1,600 |
|
2-week |
$2,100 |
$2,500 |
|
3
week |
$2,900 |
$3,400 |
|
4-week |
$3,600 |
$4,200 |
|
5-week |
$4,300 |
$4,900 |
|
6-week |
$4,900 |
$5,500 |
|
7
week |
$5,400 |
$6,000 |
|
8-week |
$5,900 |
$6,400 |
Indicated
price includes 6 credits per session, accommodations, and two meals per day,
transportation, activities, field trips and other features listed on our
website. The fee for each additional 3-credit course is $400. A payment of $130
is required for any additional credit. Once in Italy
each student and faculty must pay a membership fee of 20 Euros in order to use
the CISD facilities, transportation etc. The fee includes a membership of
Centro Internazionale di Studi Deradiani (CISD) valid for one year and an
insurance coverage for any injury that may take place at the CISD legal
location. Please notice: Living with a family requires an additional payment of
70 Euros.
Registration data (optional): The objective of our program
is to promote a community of learning and teaching. To this end, please write a brief paragraph in the
space below explaining why you feel this program is suitable for you. Please also let us know if you are interested in
having a particular experience while in our program. Also, please let us know
if you need any special accommodation or assistance. Moreover if you have any
allergy to food or if you are a vegetarian please indicate your food preference
(Attach an additional page or use the back of this page if necessary):
Please enclose a $100
non-refundable deposit. The remaining tuition balance is due by the first week
of May, 2012. All checks or money
orders should be in US dollars and should be made out to: De Rada Italian
Institute, Inc. For other
payment methods (credit card, wire transfer, etc.), please contact us by email:
info@derada.com. Please send your
application to: De Rada Italian Institute, 37 Kingston Hill Ct.,
Kingston, RI 02881 USA. If mailing the application for you is a
problem (for instance you are late, or you live in a foreign country, or too
far from a post office, etc.), you can also email it to us.
Signature:__________________________________________ Date:______________________