Community Language Program (CLP)

First Name:*

Middle Initial:

Last Name:*

Date of Birth (use format mm/dd/yyyy):*

Street Address: *

Street Address 2:

City: *

State: *

Zip: *

Country:*

Home Phone:*

Work Phone:

Cell Phone:

E-mail: *

Organization:

Occupation:

If yes, please specify:

If yes, please specify:

How did you hear about the Rassias Center?*
-Select One- Word of Mouth Web Search Brochure Other, please specify below

If other, please specify:

How did you hear about this semester’s CLP program?*
-Select One- Word of Mouth Web Search Brochure Dartmouth Listserve Valley News Other, please specify below

If other, please specify:

What is your native language?*

Please provide details on your experience with the language you are registering for (course work and/or life experience):*

Language self-evaluation* (the language you are registering for)
-Select One- None/very limited Can communicate basic information Can express myself in short phrases Can converse and express myself in sentences

Rassias Center Community Language Program

Language * Select One... English Grammar & Pronunciation-Morning French Italian Spanish

We will contact you to arrange a telephone placement interview (if necessary) upon receipt of your registration.