Seattle Language & Culture Institute Registration for International Individual Participants

This form is for residential participants who are registering as individuals. To submit a form to register as a group, please click here.

After you complete your registration, you will be sent to a page with a payment link to pay via credit card (you can also open the payment page here). If you would like to pay via bank transfer, please complete this form and then contact Ellen Frierson at ellen@fiuts.org for details.

First Name

Last Name

Preferred Name

First Name

Last Name

First Name

Last Name

Email Address

Gender

Participant's Home Country

Participant's First Language

Home Address

(Street, city/town, state/province)

Name of School

Date of Birth

YYYY

Primary Email Address

How did you find out about SLCI?

Parent/Guardian Name

Relationship to participant

Phone Number

Country

(###)

###

####

Email address

Parent/Gaurdian Name

First Name

Last Name

Relationshipto Participant

Phone Number

Country

(###)

###

####

email address

Medical Insurance Provider

All participants are required to carry international student health insurance during their time with the Seattle Language and Culture Institute. If you would like for FIUTS to purchase insurance for the participant, please write "FIUTS" here and choose the option to add insurance to your program fee for an additional $40 USD when you make your payment. If you will be purchasing your own insurance, please include the information here and send proof of insurance to ellen@fiuts.org.

Policy Number

Does the participant have any allergies and/or intolerances to food, medication, animals, or any other substances? If so, what are the symptoms and action to be taken, if any?

Please provide information about any medications that the participant will be taking during the program day.

Does the participant require any special accommodations? If so, please describe.

Emergency Contact Name

Relationship to Participant

Emergency Contact E-mail Address

Please describe your English language experience?

This section should be filled out by the student participating in the Seattle Language and Culture Institute. Include number of years you have studied English in school and any other experience you have learning/studying English.

Do you have any previous travel experience? If so, where did you go, how long were you there, and what was the purpose of your trip (vacation, study, visiting family, etc.)?

Do you have any previous experience with volunteer or leadership activities? If so, please describe.

What do you hope to learn during the Language & Culture Institute?

Seattle Language & Culture Institute Registration for International Individual Participants

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