Name and surname *

Date of birth *

Address *

Phone *

Email *

Occupation

Native language / other languages spoken *

I wish to enroll in the following course *

From / to *

My level of italian *
I don’t speak italianElementaryIntermediateUpper-intermediateAdvanced

Accommodation

in a family with breakfastin a family with half boardin a shared flatin an independent flatin a hotelnot required

single roomdouble room

Any particular needs or comments:

I read (privacy) the privacy policy and agree to my personal data treatment in accordance with the new regulations which enter into force on 25 May 2018, the G.D.P.R. General Data Protection Regulation - Regulation(EU) 2016/679.