ESL Adventure for Au Pairs

After completing this form you will be enrolled in the ESL Au Pair class. You will receive a confirmation email within 1-3 days. Upon successful completion of the course you may request a certificate of completion. Using this form we will create a Madison College student account for you.

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* Student Personal Information. Use your American Address (it is where your bill will be sent).

First Name

Last Name

Date of Birth

Email Address

Student ID # (if known)

Phone

Street Address

City

State

Zip

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* Confirm your Email Address

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* Where are you from?

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* By filling out this form you are agreeing to be billed and pay for ESL Adventure for Au Pairs. Please note your bill will state "ESL for Au Pairs 1" and "ESL for Au Pairs 2" for $174.50/each for a total of $349. You will receive your bill in the mail but can choose to pay online through your student account.

I understand.

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* Select the ethnicity you most identify with (optional)

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* Gender (optional)