De La Salle Language Institute


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Apply for 2008 Summer Language Program 3 Weeks: June 23 - July 12, 2008

Student Information

* Last / Family Name

* First Name

* Middle Name

* Street Addres or P.O. Box

* City

* State or Province

Postal Code

* Country

* Home Phone (Country code-City code-Number)

* Fax (Country code-City code-Number)

* Email Address

Family Information

* Father or guardian's name

* Occupation

* Work Phone Number

Work Fax Number

* Emergency Contact Name

* Fax Number

* Telephone Number

Education Information List all secondary/high schools and post-secondary schools attended (most recent first)

* School #1

* City

* State

* Dates Attended

* Date of Diploma or Degree

School #2

State

City

Dates Attended

Date of Diploma or Degree

School #3

City

State

Dates Attended

Date of Diploma or Degree

DLI Program Information

* What is your level of English proficiency?
	Beginner Intermediate Advanced TOEFL (Enter Score on next line)

TOEFL Score (if applicable)

* How did you become interested in De La Salle Institute of Saint Mary's University?
	Academic Reputation Advertisement Alumnus Brochure Christian Brothers (De La Salle) Other

* Required Fields

Updated by Website Editor - Winona on Wednesday, April 23, 2008. Contact: webeditor@smumn.edu