On-Line Enrollment Form
1. Personal Information
*
Last Name
*
First Name
*
Home Address: Street and Number
*
City
*
ZIP
*
Telephone
*
e-mail:
2. Program of study
*
Please select your language:
Arabic
Chinese
French
German
Italian
Japanese
Korean
Latin
Portuguese
Russian
Spanish
Spanish, Conversation
American Sign Language
Other: Please contact our Program Coordinator at 213.381.6707.
*
Starting date
*
Ending date
3. Payment
*
One-time Application Fee (non-refundable), $75
*
Name on Card
*
Credit Card Type
Visa
MasterCard
American Express
Discover
*
Credit Card Number
*
CSC Code
*
Expiration Date (mm/yy)
*
Indicates Response Required