ÿþ<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Final//IT"> <html> <head> <meta name="description" content="Italian language school in Italy, Bologna. Intensive, individual, special courses and seminaries on Italian culture."> <meta name="GENERATOR" content="Microsoft FrontPage 4.0"> <meta name="keywords" content="italian language school, italian language course, study italian abroad, study abroad in italy, bologna, study and travel, italy, italian culture, learn italian, study italian, italian for foreigners, language school, italian courses, italian lessons, beginner course, intensive course, italian school, learning italian abroad, italianoit, lesson, Italian grammar, application form, application on line"> <meta name="ProgId" content="FrontPage.Editor.Document"> <title>Italian language school application form</title> <link rel="stylesheet" type="text/css" href="../itstile.css"/> <link rel="stylesheet" type="text/css" href="../modulo.css"/> </head> <body bgcolor="#ffffff" leftmargin="0" topmargin="0"> <FORM METHOD=POST ACTION="http://www.dada.it/cgi-bin/formmail.pl"> <font size="4"><b> WE ARE CURRENTLY EXPERIENCING TECHNICAL DIFFICULTIES.</b><br> <b> PLEASE COPY AND PASTE YOUR COMPLETED APPLICATION FORM IN AN EMAIL MESSAGE ADDRESSED TO: school@italianoit.it</b> <br> <b> WE APOLOGISE FOR THE INCONVENIENCE!</b></font> <table border="0" cellspacing="0" cellpadding="0" width="100%" height="808"> <tr> <td valign="top" colspan="2" height="80" > <table border="0" cellspacing="0" cellpadding="0" width="100%"> <tr> <td background="../elements/spessore.jpg" ><img src="../elements/cornice1.jpg" height="88"></td> <td background="../elements/spessore.jpg"><img src="../elements/logo.jpg" ALT="" "Liceo Linguistico Internazionale" BORDER=0 height="88" width="190"></td> <td background="../elements/spessore.jpg" ><IMG SRC="../elements/spessore.jpg" ALT="" BORDER="0" height="88"></td> <td><img src="../elements/puntatop.jpg" ALT="" BORDER="0" height="88" width="94"></td> <td valign="top" align="center"><a href="form.html" class="tasti"><img src="../button/iscrizio.gif" width="40" height="40" border="0" alt="Application form"></a><br><a href="form.html" class="tasti">Application</a></td> <td valign="top" align="center"><a href="contatti.html" class="tasti"><img src="../button/luoghi.gif" width="40" height="40" border="0" alt="Info"></a><br> <a href="contatti.html" class="tasti">Contacts</a></td> <td valign="top" align="center"><a href="corsi.html" class="tasti"><img src="../button/attivita.gif" border="0" alt="Courses and fees" width="40" height="40"></a><br><a href="corsi.html" class="tasti">Courses</a></td> <td valign="top" align="center"><a href="calendario.html" class="tasti"><img src="../button/tempi.gif" border="0" alt="Timetable" width="40" height="40"></a><br> <a href="calendario.html" class="tasti">Times</a></td> </tr> </table> </td> </tr> <tr> <td background="../elements/cornice2.jpg" height="88"><img src="../elements/cornice2.jpg" ALT="" BORDER="0" height="32" width="86"></td> <td rowspan="8" width="100%" height="728"> &nbsp; <table border="0" cellspacing="0" cellpadding="0" bgcolor="lightyellow" align="center"> <tr> <td background="../elements/riga.gif" height="3"><img src="../elements/riga.gif" height="3" width="21"></td> <td height="3"><img src="../elements/top.gif" height="3" width="32"></td> </tr> <tr> <td width="400" vAlign="top"> <table border=0> <tr> <th colspan="4">&nbsp; <INPUT TYPE="hidden" NAME="mailto" VALUE="school@italianoit.it"> <INPUT TYPE="hidden" NAME="subject" VALUE="Application Form"> <INPUT TYPE="hidden" NAME="redirect" VALUE="http://www.italianoit.it/english/grazie.htm"> Application Form<br> </th> </tr> <tr> <td colspan="4" background="../elements/riga.gif" height="3"></td> </tr> <tr> <td>Name</td> <td><INPUT TYPE="TEXT" NAME="nome"></td> <td>Surname</td> <td><INPUT TYPE="TEXT" NAME="cognome"></td> </tr> <tr> <td>Date of Birth</td> <td><SELECT NAME="gg_nasc" > <OPTION>gg</OPTION> <OPTION>1</OPTION> <OPTION>2</OPTION> <OPTION>3</OPTION> <OPTION>4</OPTION> <OPTION>5</OPTION> <OPTION>6</OPTION> <OPTION>7</OPTION> <OPTION>8</OPTION> <OPTION>9</OPTION> <OPTION>10</OPTION> <OPTION>11</OPTION> <OPTION>12</OPTION> <OPTION>13</OPTION> <OPTION>14</OPTION> <OPTION>15</OPTION> <OPTION>16</OPTION> <OPTION>17</OPTION> <OPTION>18</OPTION> <OPTION>19</OPTION> <OPTION>20</OPTION> <OPTION>21</OPTION> <OPTION>22</OPTION> <OPTION>23</OPTION> <OPTION>24</OPTION> <OPTION>25</OPTION> <OPTION>26</OPTION> <OPTION>27</OPTION> <OPTION>28</OPTION> <OPTION>29</OPTION> <OPTION>30</OPTION> <OPTION>31</OPTION> </SELECT>&nbsp;/&nbsp;<SELECT NAME="mm_nasc" > <OPTION VALUE=" ">mm <OPTION>01</OPTION> <OPTION>02</OPTION> <OPTION>03</OPTION> <OPTION>04</OPTION> <OPTION>05</OPTION> <OPTION>06</OPTION> <OPTION>07</OPTION> <OPTION>08</OPTION> <OPTION>09</OPTION> <OPTION>10</OPTION> <OPTION>11</OPTION> <OPTION>12</OPTION> </SELECT>&nbsp;/&nbsp;<SELECT NAME="aa_nasc" > <OPTION VALUE=" ">yyyy <OPTION>1987</OPTION> <OPTION>1986</OPTION> <OPTION>1985</OPTION> <OPTION>1984</OPTION> <OPTION>1983</OPTION> <OPTION>1982</OPTION> <OPTION>1981</OPTION> <OPTION>1980</OPTION> <OPTION>1979</OPTION> <OPTION>1978</OPTION> <OPTION>1977</OPTION> <OPTION>1976</OPTION> <OPTION>1975</OPTION> <OPTION>1974</OPTION> <OPTION>1973</OPTION> <OPTION>1972</OPTION> <OPTION>1971</OPTION> <OPTION>1970</OPTION> <OPTION>1969</OPTION> <OPTION>1968</OPTION> <OPTION>1967</OPTION> <OPTION>1966</OPTION> <OPTION>1965</OPTION> <OPTION>1964</OPTION> <OPTION>1963</OPTION> <OPTION>1962</OPTION> <OPTION>1961</OPTION> <OPTION>1960</OPTION> <OPTION>1959</OPTION> <OPTION>1958</OPTION> <OPTION>1957</OPTION> <OPTION>1956</OPTION> <OPTION>1955</OPTION> <OPTION>1954</OPTION> <OPTION>1953</OPTION> <OPTION>1952</OPTION> <OPTION>1951</OPTION> <OPTION>1950</OPTION> <OPTION>1949</OPTION> <OPTION>1948</OPTION> <OPTION>1947</OPTION> <OPTION>1946</OPTION> <OPTION>1945</OPTION> <OPTION>1944</OPTION> <OPTION>1943</OPTION> <OPTION>1942</OPTION> <OPTION>1941</OPTION> <OPTION>1940</OPTION> <OPTION>1939</OPTION> <OPTION>1938</OPTION> <OPTION>1937</OPTION> <OPTION>1936</OPTION> <OPTION>1935</OPTION> <OPTION>1934</OPTION> <OPTION>1933</OPTION> <OPTION>1932</OPTION> <OPTION>1931</OPTION> <OPTION>1930</OPTION> <OPTION>1929</OPTION> <OPTION>1928</OPTION> <OPTION>1927</OPTION> <OPTION>1926</OPTION> <OPTION>1925</OPTION> <OPTION>1924</OPTION> <OPTION>1923</OPTION> <OPTION>1922</OPTION> <OPTION>1921</OPTION> <OPTION>1920</OPTION> </SELECT></td> <td align="right">male:<input type="radio" value="maschio" checked name="sesso"></td><td>female:<input type="radio" name="sesso" value="femmina"></td> </tr> <tr> <td colspan="2">E-mail <INPUT TYPE="TEXT" NAME="email"></td> <td colspan="2" NOWRAP>Place of birth <INPUT TYPE="TEXT" NAME="nasc_luogo"></td> </tr> <tr> <td>Tel.</td> <td><INPUT TYPE="TEXT" NAME="telefono"></td> <td>Nationality</td> <td><INPUT TYPE="TEXT" NAME="nazione"></td> </tr> <tr> <td>Fax</td> <td><INPUT TYPE="TEXT" NAME="fax"></td> <td>Mother tongue</td> <td><INPUT TYPE="TEXT" NAME="lingua"></td> </tr> <tr> <td colspan="4">Permanent address<INPUT TYPE="TEXT" NAME="indirizzo" SIZE="40"></td> </tr> <tr> <td colspan="4" background="../elements/riga.gif" height="3"></td> </tr> <tr> <td colspan="2">My level of Italian language <td colspan="2"> <SELECT NAME="Livello" SIZE=1 > <OPTION VALUE=" ">----------level-----------</option> <OPTION>absolute beginner</option> <OPTION>elementary</option> <OPTION>intermediate</option> <OPTION>advanced</option> </SELECT></td> </tr> <tr> <td colspan="2"> I would like to enroll in the following</td> <td colspan="2"> <SELECT NAME="Corso" SIZE=1 > <OPTION VALUE=" ">--------Course---------</option> <OPTION>Intensive</option> <OPTION>Semi Intensive</option> <OPTION>Small groups</option> <OPTION>Individual</option> <OPTION>Evening</option> </SELECT></td> </tr> <tr> <td colspan="2">If you decide for a special course, please specify the subject</td> <td colspan="2"><INPUT TYPE="TEXT" NAME="altro"></td> </tr> <tr> <td colspan="2" ALIGN="right">From: <INPUT TYPE="TEXT" NAME="dal" SIZE=4></td> <td colspan="2">to: <INPUT TYPE="TEXT" NAME="al" SIZE=4></td> </tr> <tr> <td colspan="4" background="../elements/riga.gif" height="3"></td> </tr> <tr> <td colspan="2">I would prefer the following accommodation:</td> <td colspan="2"><SELECT NAME="alloggio" SIZE=1 > <OPTION>---------------------none---------------------</option> <OPTION>Single room (with use of kitchen)</option> <OPTION>Single room (no use of kitchen)</option> <OPTION>Double room (with use of kitchen)</option> <OPTION>Double room (no use of kitchen)</option> </SELECT></td> </tr> <tr> <td colspan="4">I will arrive with my car: no:<input type="radio" value="si" checked name="auto">yes:<input type="radio" name="auto" value="no"></td> </tr> <tr> <td colspan="2">Allergies: no:<input type="radio" value="si" checked name="allergia">yes:<input type="radio" name="allergia" value="no"></td> <td colspan="2">smoker: no<input type="radio" value="no" checked name="fuma">yes:<input type="radio" name="fuma" value="si"></td> </tr> <tr> <td colspan="4" background="../elements/riga.gif" height="3"></td> </tr> <tr> <td colspan="4"><ol> <li><input type="radio" value="cheque" checked name="paga">I sent a deposit of Euro 100,00 by postal Money Order (or Eurocheque) to Associazione Professionale Didattica, Via Procaccini 26/2, 40129 Bologna Italy.</li> <li><input type="radio" name="paga" value="banca"> I sent Euro 100,00 as a deposit paid by bank transfer to:<br>Associazione Professionale Didattica<br> <i>IBAN</i>: IT 54 N 06385 02417 07400017073A&nbsp;<br> <i>BIC</i>: IBSPIT2B&nbsp; <br> with BANCA CARISBO (Cassa di Risparmio di Bologna) filiale Mercato<br>Via Fioravanti 22,&nbsp; I-40129 Bologna&nbsp;</li> </ol> <p align="center"><b> All ensueing bank fees to be payed by students</b></p> Date <INPUT NAME="data" value="__/__/____" SIZE="8"></td> </tr> <tr> <td colspan="4" align="center"><INPUT TYPE="Submit" Value="Submit"></td> </tr> </table> </td> <td valign="top" bgcolor="lightyellow" background="../elements/filo.gif"><img border="0" src="../elements/filo.gif" width="32" ></td> </tr> <tr> <td>&nbsp;</td> <td rowspan="2"><A HREF="index.html"><IMG SRC="../elements/sfera.gif" ALT="Home" BORDER=0 width="32" height="34"></td> </tr> <tr> <td bgcolor="#FFFFFF">&nbsp;</td> </tr> </table> </td> </tr> <!-- aggiungi spazio --> <tr> <td background="../elements/cornice2.jpg" align="center" height="26"><A HREF="bologna.html" class="bar_or">Bologna</A></td> </tr> <tr> <td background="../elements/cornice2.jpg" align="center" height="27"><A HREF="mappa.html" class="bar_or">Map</A></td> </tr> <tr> <td background="../elements/cornice2.jpg" align="center" height="47"><A HREF="alloggio.html" class="bar_or">Accom-<br>modation</A></td> </tr> <tr> <td background="../elements/cornice2.jpg" align="center" height="30"><a href="links_ing.html" class="bar_or">Links</a></td> </tr> <tr> <td background="../elements/cornice2.jpg" align="center" height="41"><a href="../album.html" class="bar_or" target="_blank">Photo<br> Album</a></td> </tr> <tr> <td background="../elements/cornice2.jpg" align="center" height="41"><a href="regolamento.html" class="bar_or">Rules and conditions</a></td> </tr> <tr> <td background="../elements/cornice2.jpg" align="center" height="87"><img src="../elements/cornice2.jpg" ALT="" BORDER="0" height="32" width="86"></td> </tr> <tr> <td vAlign="top" height="382"><img src="../elements/puntabot.jpg" ALT="" BORDER="0" height="146" width="86"></td> </tr> </table> </form> </body>