MULTICULTURAL CLASSROOM APPLICATION FORM

All information will remain confidential. 

Name *
Name
Birthdate *
Birthdate
If in college, please indicate your major as well.
Phone Number *
Phone Number
Including country code
What aspect of the language would you like to focus to? *
When would you like to start your class? *
When would you like to start your class?
When would you like to end your class? *
When would you like to end your class?
On what days would you like your classes to be? *
What time? *
Agreement *
Should you wish to cancel a class because of important reasons, you may do so by informing ACOPIA not more than 24hrs before your class. ACOPIA will not honor refunds for classes cancelled less than 48 hours before the scheduled class.