Ulpan Registration Form printable pdf download

ULPAN REGISTRATION FORM

Summer 2014 (June 16-July 25, 2014)

Name: _________________________________________________________________________________ Sex  M  F

Address: ___________________________________________________________________________________________

City: _____________________________________________________ State: ____________ ZIP: ___________________

Phone: (day) _____________________________ (evening) ____________________ (cell) _________________________

Email: __________________________________________________________ Birthday: __________________________

Social Security number: _____________________________________________ Student ID: _______________________

Please complete both columns below:

Check appropriate level

Check time(s) preferred. Please include all possibilities.

(schedule is subject to enrollment)

Beginner

□ 1 (beginner)

Once a week:

□ 2 (mid-beginner)

□ Friday, 9:30 a.m.-12:30 p.m (Levels 2-9)

□ 3 (advanced-beginner)

□ Tuesday, 9:30-11:30 a.m. (Chug)

□ Wednesday, 6:30-8:30 p.m. (Chug)

Intermediate

□ 4 (low-intermediate)

□ 5 (mid-intermediate)

Twice a week:

□ 6 (high-intermediate)

□ Monday and Wednesday, 9:30-11:20 a.m. (Levels 1-9)

□ Monday and Wednesday, 6:30-8:20 p.m. (Levels 1-9)

Advanced

□ 7 (low-advanced)

□ Tuesday and Thursday, 9:30-11:20 a.m. (Levels 2-6)

□ 8 (mid-advanced)

□ 9 (high-advanced)

Four times a week: Monday through Thursday

□ 10 Chug

□ 9:30-11:20 a.m. (Levels 1-4)

Tuition and Fees:

(Tuition includes a non-refundable registration fee)

□ Once or twice a week: $545 total

□ Four times a week: $745 total

□ Chug: $345 total

Mail this form with your payment to:

Hebrew College Ulpan

160 Herrick Road

□ Check enclosed (payable to Hebrew College)

Newton Centre, MA 02459

□ MasterCard

□ Visa

Name on Card _______________________________

Card Number _______________________________

Security Code ________ Expiration Date _________

Signature ___________________________________

Please note: Ulpan classes are generally non-academic courses, although an academic credit option may be available at a

different rate than listed above. For complete information, please contact Tzilla Barone at 617-559-8812.

Ulpan courses are not eligible for any discounts. Registration fees are required for Ulpan courses even if you are taking

other courses simultaneously through Hebrew College.

Ulpan students are responsible for notifying the office in writing of their intent to withdraw from a class. Mere absence

from class does not reduce financial obligation. Students withdrawing during the first week of classes are eligible to

receive a 50 percent refund of tuition; after the first week, no refund will be given.

Ulpan Registration Form

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