San Diego City College REGISTRATION for Fall 2010 in Buenos Aires, Argentina

Event: *
Departure City: *
Departure Day: *

First Name: * Name as it appears on your passport
Middle:
Last Name: *
Date of Birth: * Please note: applicants must be at least 18 years of age at time of departure	Please Select 1 2 3 4 5 6 7 8 9 10 11 12 Please Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Please Select 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
Gender: *	Male Female
Email Address: *
Mailing Address: *
City: *
State/Province: *
Zip / Postal Code: *
Home Phone: *
Work Phone:
Cell Phone:
Nationality : *	Please Select United States Andorra United Arab Emirates Afghanistan Antigua and Barbuda Anguilla Albania Armenia Netherlands Antilles Angola Antarctica Argentina American Samoa Austria Australia Aruba Azerbaijan Bosnia and Herzegovina Barbados Bangladesh Belgium Burkina Faso Bulgaria Bahrain Burundi Benin Bermuda Brunei Darussalam Bolivia Brazil Bahamas Bhutan Bouvet Island Botswana Belarus Belize Canada Cocos (Keeling) Islands Congo, the Democratic Republic of the Central African Republic Congo Switzerland Cote D'Ivoire Cook Islands Chile Cameroon China Colombia Costa Rica Serbia and Montenegro Cuba Cape Verde Christmas Island Cyprus Czech Republic Germany Djibouti Denmark Dominica Dominican Republic Algeria Ecuador Estonia Egypt Western Sahara Eritrea Spain Ethiopia Finland Fiji Falkland Islands (Malvinas) Micronesia, Federated States of Faroe Islands France Gabon United Kingdom Grenada Georgia French Guiana Ghana Gibraltar Greenland Gambia Guinea Guadeloupe Equatorial Guinea Greece South Georgia and the South Sandwich Islands Guatemala Guam Guinea-Bissau Guyana Hong Kong Heard Island and Mcdonald Islands Honduras Croatia Haiti Hungary Indonesia Ireland Israel India British Indian Ocean Territory Iraq Iran, Islamic Republic of Iceland Italy Jamaica Jordan Japan Kenya Kyrgyzstan Cambodia Kiribati Comoros Saint Kitts and Nevis Korea, Democratic People's Republic of Korea, Republic of Kuwait Cayman Islands Kazakhstan Lao People's Democratic Republic Lebanon Saint Lucia Liechtenstein Sri Lanka Liberia Lesotho Lithuania Luxembourg Latvia Libyan Arab Jamahiriya Morocco Monaco Moldova, Republic of Madagascar Marshall Islands Macedonia, the Former Yugoslav Republic of Mali Myanmar Mongolia Macao Northern Mariana Islands Martinique Mauritania Montserrat Malta Mauritius Maldives Malawi Mexico Malaysia Mozambique Namibia New Caledonia Niger Norfolk Island Nigeria Nicaragua Netherlands Norway Nepal Nauru Niue New Zealand Oman Panama Peru French Polynesia Papua New Guinea Philippines Pakistan Poland Saint Pierre and Miquelon Pitcairn Puerto Rico Palestinian Territory, Occupied Portugal Palau Paraguay Qatar Reunion Romania Russian Federation Rwanda Saudi Arabia Solomon Islands Seychelles Sudan Sweden Singapore Saint Helena Slovenia Svalbard and Jan Mayen Slovakia Sierra Leone San Marino Senegal Somalia Suriname Sao Tome and Principe El Salvador Syrian Arab Republic Swaziland Turks and Caicos Islands Chad French Southern Territories Togo Thailand Tajikistan Tokelau Timor-Leste Turkmenistan Tunisia Tonga Turkey Trinidad and Tobago Tuvalu Taiwan, Province of China Tanzania, United Republic of Ukraine Uganda United States Minor Outlying Islands Uruguay Uzbekistan Holy See (Vatican City State) Saint Vincent and the Grenadines Venezuela Virgin Islands, British Virgin Islands, U.s. Vietnam Vanuatu Wallis and Futuna Samoa Yemen Mayotte South Africa Zambia Zimbabwe
Passport Number: *
Passport Expiration Date: *

College(s) currently attending: *
Current number of units enrolled in: *
Total number of units completed: *
Cumulative GPA: *

Please list the classes that you plan to take in Argentina: * Argentine Life and Culture (required)

Last Name: *
First Name: *
Address: *
City: *
State / Province: *
Zip / Postal Code: *
Phone (Day): *
Phone (Evening):
Cell Phone:
Email: *
What is your relationship to this individual: *

Do you plan to participate in the group flight departing San Diego on August 26th, with return flight from Buenos Aires on November 6th?: *

Yes No

Please select a option *
OPTION A: Homestay -single room -with breakfast and dinner $5,899/ *$4,799 * without flight
OPTION B: Shared apartment - single room - multiple bedrooms - no meals $5,599/ *$4,499 * without flight

Name(s) of preferred apartment / home stay mate(s):
Do you smoke?: *	Yes No
Do you object to a housemate or apartment mate smoking?: *	Yes No
Homestays with meals: Do you have any dietary preferences?: Please be specific. E.g. Lactose intolerant, vegan.
Are there any important physical needs or illnesses that your local hosts should know about?:
Do you object to family pets?: * (homestays only)	Yes No
Do you have allergies to pets: *	Yes, type No
Do you have any other allergies: *	Yes, list No
Do you prefer a host family with children?: *	Yes No
Any other additional requests or special needs?:

This information is exclusively for the use of Expanish staff in order to ensure your health and safety while studying abroad. Any information that you disclose will remain entirely confidential.

How would you rate your general health?: *	Excellent Good Fair Poor
Blood Type: *
Do you have any special dietary needs?: (including a vegetarian diet)	Yes, please specify below
Do you have any drug or food allergies or chronic conditions?:	Yes, please specify below
Medical History: (please check all that apply)	Diabetes Hypertension Depression Cardiovascular disease Epilepsy or other neurological disorder Eating disorder (anorexia, bulimia, overweight) Are you under medical treatment?

Do you have any recent or continuing health or medical problems for which your are currently receiving treatment: *	No If Yes, please specify below
Are you presently taking any prescription medications on a regular basis?: *	No Yes, please indicate name of medication and what condition the medication is used to control
Do you have any physical conditions that require special consideration?: *	No If Yes, please specify below
Are you a cigarette smoker?: *	Never No, but ex-smoker Yes, how many packs per/day
Do you use any other forms of tobacco?: *	No Yes, Number of years of tobacco use
Do you require any special accommodation in order to study abroad?: *	No Yes, Please specify below

Please read the General Terms and Conditions, including the Expanish Terms and Conditions before submitting your registration form. Include a deposit of $500 with this registration form.

Payments should be made in U.S dollars by credit card (Mastercard, Visa, American Express, Discover) or via PayPal.

To Pay By Credit or Debit Card:

In order to pay by credit/debit card you can Contact Expanish with the card information requested below, or you may call our office during business hours here in Buenos Aires (-2 GMT, 10 AM - 7 PM) toll free at +1 888 397 2647 (USA). Please ask to speak to a member of our University Staff and be prepared with the following:

• Name on Card
• Card Type and Number
• Expiration Date
• Security Code (3 digits)

To Pay By PayPal:

You can send your money directly to Expanish via Paypal to accounting@expanish.com IMPORTANT - You must e-mail Expanish Study Abroad (university@expanish.com) a copy of your transaction receipt or the receipt ID number to inform us that the payment has been made.

For Instructions: Go to www.paypal.com and, if you already have an account, Log In; if you do not have an account, please Sign Up for a PayPal account. During Sign Up, you will have to input a credit card or debit card number into your account. Once you are logged into this account, you will find a tab that is labelled "Send Money", please click here. Enter the Expanish email address, accounting@expanish.com, and the corresponding amount and currency (United Stated dollars), as well as the type of purchase (services). Click "continue" and complete payment following PayPal instructions.

Payment Schedule		Amount
Program registration deposit due:	April 27	$500
Second payment due:	May 29	$3,000
Program balance due:	June 27	Full Program price

Deferred Payment Schedule for Financial Aid Recipients
Program registration deposit due:	April 27	$500
Second payment due:	May 29	$1,500*
Program balance due:	August 19	Full Program price

*If there is an outstanding balance between the student's financial aid amount to be awarded and $1,500, the student will be responsible for paying the difference by May 29th.

For information about applying for Financial Aid, please contact the San Diego City College Financial Aid Office (619) 388-3501.

Students who are applying for financial aid and who are unable to meet the program payment schedule will instead adhere to the deferred payment schedule.

Are you applying for Financial Aid to assist with program fees? * No Yes

How did you hear about this study abroad program?: *

Class Schedule Flyer City College website Friend Professor Newspaper Other, specify below

I have read and agree to the General Terms and Conditions in addition to all registration requirements. All participants must be at least 18 years or older by the date of program departure. Acceptance is based on program space availability and may be subject to SDCC selection criteria.