Name: * (LAST, First, Middle) Program Information Desired class size: * Individual Group class(2-6 students) Classes are offered Monday through Friday, for 4 hours a day, for a total of 100 hours The cost of a group class of 100 hours is $1200 Registration fees and welcome pack are $35 Group Class Schedule June 12th - July 21st 2017 August 14th - September 24th 2017 October 9th - November 17th 2017 Desired Starting Date: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year201820192020 Language Requested: * - Select -WolofFrenchPuulaarMandinka Level: * - Select -BeginnerIntermediateAdvanced Total Number of Hours: * Please, don't put any space between the digits! Spoken Languages: * Proposed Schedule: Planned Date of Arrival to Senegal: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20162017201820192020 Homestay Homestay Desired?: * Yes No Homestay Duration: 2 weeks 4 weeks 6 weeks 8 weeks Would you prefer to be placed with another student or by yourself ?: Do you smoke ?: No Yes Can you live with smokers ?: No Yes Food or dietary restrictions, if any: Please briefly describe yourself and your own family: Airport Pickup Arrival: Yes No Departure: Yes No Personal Information Birthdate: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003 Gender: * - Select -MaleFemale Nationality: * Email: * Confirm email: * Phone: * Please, don't put any space between the digits! Address: * Office/University: Profession/Title: How I learned about the Baobab Center How I learned about the Baobab Center: CAPTCHACette question consiste à tester si vous êtes ou non un visiteur humain et à éviter les demandes automatisées de spam.