Bridging The Gap Application Acutrans printable pdf download

Bridging The Gap Application Acutrans

“ A c c u r a c y I n t e g r i t y R e l i a b i l i t y ”

Bridging the Gap (BTG) Medical Interpreter Training

APPLICATION FORM

Please type or print carefully

September 26 – October 10, 2015

Dates:

Location:

Accurate Translation Office

9525 S. 79

Ave., Suite 6 (first floor)

Hickory Hills, IL 60457

Application Deadline: August 15, 2015

*A $100.00 non-refundable application fee is due with application.

Full or partial payment is due on the first day of class. Partial payment is half of the

remaining tuition cost ($450.00). The remaining balance is due before student receives

certificate. Payment can be made by check, cash or credit card. Checks made payable to

Accurate Translation.

Name: _________________________________________________________________

Job Title: _______________________________________________________________

Address: _______________________________________________________________

City/State/Zip: ___________________________________________________________

Day Phone: ________________ Fax: _________________ Cell: ___________________

Email: _______________________________

Gender: ______________________________

Preferred day and time to do language proficiency assessment: ____________________

(No guarantee that we can meet your preferred time & date but we will try to match your preference.)

Primary Language: ____________________ Second Language: __________________

Third Language, if any: ___________________

Please note: Upon receipt of your completed application form and non-refundable deposit,

we will notify you by email of your language proficiency assessment schedule.

Bridging The Gap Application Acutrans