Centro di Cultura Italiana Casentino
"Piero della Francesca"
Italian Language and Culture School

Application Form

Name *:

Address *:

City *:

State *:

Phone *:

E-mail *:

Profession:

Nationality:

Native Language:

Age:

How did you first
hear about C.C.I.C.?

Questions:

* fields to be completed

How do you evaluate your knowledge of the Italian language?:

Which other languages do you speak?

I herewith enrol for the following Italian course:

italian language course

from:

/

to:

/

complementary course

Accomodation: 

single room

double room

Will you be arriving by car?

yes

Are you vegetarian? 

yes

Are you a non-smoker?

yes

Notes:

Upon submitting your application form, a deposit of 238,00 Euro (for a two-week course) is requested. (Please note that we can only accept payments made in EURO and NOT in Euro equivalent. Please ask your  financial institution for assistance)

Payment should be made by bank transfer "without expenses for the beneficiary" directly to the bank account
No. 2685.31 (ABI 1030 and CAB 71582.1)

Monte dei Paschi di Siena, Filiale di Ponte a Poppi
Swift code: PASC IT MM
IBAN: IT 46 I 01030 71582 000000268531

Any additional bank charge should be paid by the student
Please write your name and  the course chosen on payment
Please send a proof of payment (receipt) by
Fax to 0039 0575 529774


C.C.I.C. "Piero della Francesca"
Centro di Cultura Italiana Casentino

Piazza Amerighi n. 1
I - 52014 Poppi (AR)
Italia

Tel. 0039 0575 529774
Fax 0039 0575 529774