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Registration Form
„Introduction to everyday communication (in German)”
Beginner 1 Level
Winter Semester 2014/2015
September 01 – October 10, 2014
Please complete this application form using your computer and send it back by mail or fax to
the following address. Information marked with an asterisk * is mandatory.
Freie Universität Berlin
Vorkurs Deutsch
c/o ERG Universitätsservice GmbH
im Auftrag der/on behalf of
Freie Universität Berlin
Otto-von-Simson-Straße 26
D-14195 Berlin
Telephone: +49-30-838 73 470
Fax:
+49-30-838 473 470
Email:
[email protected]
Web:
www.fu-berlin.de/deutsch-vorkurs
1. Personal Information
Ms.*
Mr.*
|_______________________________________________
Family name*
|_____________________________________________
First name*
Postal Address
|_______________________________________________
Street*
|_____________________________________________
Street 2 or Apt #
|________________________________________________
City*
|_____________________
State
|________________________________________________
Country*
|_____________________________________________
E-mail*
|________________________________________________
Telephone*
|_____________________________________________
Fax number
|_______ |
Date of Birth*
|______________
Zip / Postal Code*
|___________ (Day/Month/Year) |_____________________________________________
e.g.: 23 February 1983
Citizenship*
Registration Form „Introduction to everyday communication (in German)“- Winter Semester 2014/2015
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2. Academic Information / Affiliation*
My stay at Freie Universität Berlin is organized by the following institution/program:
International Office/ Direct Exchange
International Office/ ERASMUS Mobility Programs
Center for International Cooperation (CIC)
Dahlem Research School (DRS)
Master Program taught in English: ______________________________________
Other, Please specify: ______________________________________
|________________________________________________
Complete name of Home College / University*
|_______________________________________________
Major*
|_____________________________________________
Native Language*
3. Course Selection*
The course is designed for students with no or minimal prior knowledge of the German language.
In principal, classes comprise 4 contact hours per day. Courses take place in the morning.
I would like to participate in a German language Beginner 1 level course.
Information on arrival: The course begins on September 01, 2014 (and ends on October 10, 2014).
Therefore, the individual arrival must be scheduled before September 01, 2014.
Request of previous knowledge of German language. Please tick as appropriate!
I have absolutely no knowledge of the German language:
Yes, I have absolutely no knowledge of the German language.
No, I DO have some knowledge of German already.
Please specify how many hours of German you have had before:_________________________
Registration Form „Introduction to everyday communication (in German)“- Winter Semester 2014/2015
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4. Payment and Registration
The course fee is 600 EUR for exchange program students of Freie Universität Berlin (1,350 EUR for
other participants).
You will receive an e-mail registration confirmation with an invoice. The full amount indicated in the
invoice has to be paid within 7 days after the receipt of the invoice – using bank transfer or by
credit card. A place in the course can only be guaranteed after all fees have been received. Bank
transactions fees (bank transfer or credit card) have to be paid by the participant.
Participants have to inform “Vorkurs Deutsch” in writing about cancellation (an e-mail is sufficient). In
case of cancellation up to six weeks prior to the start of a given program, the participant receives a
refund of the full course tuition fee; in case of cancellation up to four weeks prior to program
start, the participant receives a refund of 50% of the course tuition fee, minus possibly applied bank
fees. No fees of any kind are refunded in case of cancellation less than four weeks prior to the start
of a given program.
Registration Deadline: Registration is possible, in principle, until August 1, 2014 or as soon as the
maximum number of participants is reached.
Please note: The number of participants per course is limited. Course spots will be assigned on a
“first come, first served” basis.
For more details, please refer to the General Terms and Conditions at:
http://www.sprachenzentrum.fu-berlin.de/downloads/daf/AGB_englisch_20121221.pdf?1357652854
5. Methods of Payment*
I wish to pay via
bank transfer in EURO (€). All bank fees have to be paid by the participant.
Recipient:
Account Holder:
Swift or BIC Code:
IBAN:
Hauptkasse der Freien Universität Berlin
DEUTDEDB110
DE97100708480512160300
Bank Address:
Berliner Bank
Hardenbergstr. 32
10623 Berlin
Germany
Reason for transfer: Familyname + Firstname / Vorkurs Deutsch
credit card
Visa Card
Master Card
Card Number ___________________________________________
(16 digits)
Expiration date: ___________/____________ (MM/YY)
Card verification number ____________ (3 digits)
Name of card holder (as printed on card):
|__________________________________
Registration Form „Introduction to everyday communication (in German)“- Winter Semester 2014/2015
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Card holder’s address:
|__________________________________
|__________________________________
|__________________________________
I, the undersigned card holder, agree that the course fee as indicated in section 4 will be withdrawn
from my credit card by the Freie Universität Berlin / Vorkurs Deutsch.
Date
Card holder’s signature
I hereby certify that the information on this registration form is complete and accurate to the best of my
knowledge. I also declare that I have read, understand and accept the General Terms and
Conditions of Vorkurs Deutsch Freie Universität Berlin – as published at www.fu-berlin.de/deutschvorkurs. Freie Universität Berlin/Vorkurs Deutsch holds no liability in case I am unable to complete the
program due to an emergency.
Date
Participant’s signature
Registration Form „Introduction to everyday communication (in German)“- Winter Semester 2014/2015
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