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University Intercultural Program Registration 2024
In order to complete registration, one must...
1. Fill out this form
2. Email goticocostarico@gmail.com the following:
PDF of signed Liability Waiver
Confirmation of payment
Copy of passport
3. V
enmo
@goticocostarica 50% of program fee (please send email/whatsapp +506-8991-3536 once payment made for confirmation)
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* Indicates required question
Name
(First, Last)
*
Your answer
Email
*
Your answer
Phone Number (all communication will be done through WhatsApp)
*
Your answer
Birthdate
(DD/MM/YY)
*
Your answer
Address
(Street, City, State, Zip)
*
Your answer
School
*
Your answer
Graduation Year
*
Your answer
Spanish Level: Comprehension
*
Beginner
Intermediate
Advanced
Spanish Level: Speaking
*
Beginner
Intermediate
Advanced
Emergency Contact Name (First, Last)
*
Your answer
Emergency Contact Phone
*
Your answer
Emergency Contact E-Mail
*
Your answer
Emergency Contact Relationship
*
Your answer
Desired Dates of Travel
*
January 8 - 18, 2024 (Register by December 8, 2023)
May 26 - June 5, 2024 (Register by April 1, 2024)
August 16 - 26, 2024 (Register by June 1, 2024)
Dietary Restrictions
Your answer
Allergies
Your answer
Medical Conditions, Medications, Treatment Plan
Your answer
Anything else we should know while you travel with us?
Your answer
How did you hear about our student trips
*
Word of mouth
Social Media
Direct Email
Google
School Email
Other:
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