Distance course Application form
Student information:
First Name: *
Your answer
Family Name: *
Your answer
Gender:
Nationality: *
Your answer
Birthdate: *
MM
/
DD
/
YYYY
Telephone: *
Your answer
Email: *
Your answer
Mailing Address:
Street and home number: *
Your answer
City: *
Your answer
State/Province: *
Your answer
Zip code/ Postal code: *
Your answer
Country: *
Your answer
Occupation and educational backgrounds:
Name of School/University: *
Your answer
Degree received: *
Your answer
Occupation: *
Your answer
What languages other than English do you know?
Your answer
What is your proficiency level in Ukrainian? *
(choose one in each category)
No proficiency
Beginner
Intermediate
Upper-Intermediate
Advanced
Speaking
Writing
Reading
Course Details:
How many lessons would you like to take? *
(please notice one lesson continues 45 minutes)
Your answer
Would you like to take course for credit? *
Please write your Skype name. *
(if you do not have, please create one - that is how you will communicate with teacher)
Your answer
How did you learn about our courses? *
Your answer
Please describe your interest in course of Ukrainian language: *
Your answer
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