Student Application

Winter Quarter 2012: January 9 - March 16

Name (first, middle, last): *

Name of parent or guardian:

if student is less than 18 years old

Information about student

Address: *

City/State/Zip Code: *

Home Phone: *

Daytime Phone or Cell Phone:

Email Address: *

Birth date: *

How did you hear about Westminster Language Academy:

Childcare

Number of children enrolled:

Number of days each week:

Name(s) and age(s) of children:

Children’s special notes or allergies:

Partner Code

Class Selection

English for Conversation 1:

1 Day per Week: $265.00

ESL Beginner
Tuesdays 9:30 - 11:30am

English for Conversation 2:

1 Day per Week: $265.00

2 Days per Week: $445.00

ESL Low Intermediate
Tuesdays 9:30 - 11:30am and Thursdays 11:45am - 1:45pm

English for Conversation 3:

1 Day per Week: $265.00

2 Days per Week: $445.00

ESL Intermediate
Wednesdays and Fridays 9:30 - 11:30am

English for Conversation 4:

1 Day per Week: $265.00

2 Days per Week: $445.00

ESL Advanced
Mondays and Thursdays 9:30 - 11:30am

English for Professionals:

1 Day per Week: $275.00

ESL Intermediate
Wednesdays 6:30 - 8:30pm

DISCLAIMER:

STUDENT/PARENT/GUARDIAN AGREEMENT AND PERMISSION:

I agree to and accept the terms and conditions outlined in the Student and Academy Policies.
I agree to pay tuition, fees and any financial penalties accrued by me (or my child, if applicable) due to property damage in a timely manner.
I agree to communicate my (or my child’s, if applicable) medical conditions and concerns, including any medications and/or special medical needs, to Westminster Language Academy.
I give permission to any Westminster Language Academy representative to seek medical attention for me (or my child, if applicable) in the event of a medical emergency, and I understand that I will be responsible for any and all medical expenses incurred as a result.

By submitting this application you are agreeing to follow all conditions and policies of Westminster Language Academy.

Westminster Language Academy

13646 NE 24th Street
Bellevue WA 98005

Phone: (425) 460-4041
Fax: (425) 643-7365

Directions

Student Application

Winter Quarter 2012: January 9 - March 16

Westminster Language Academy

Contact Us