Anrede/Salutation	Bitte wählen/please select Herr_Mr Frau_Mrs
Vorname/Firstname*
Name*
Strasse/street*
Hausnummer/No*
Postleitzahl/Postalcode*
Wohnort/City*
Land	Andorra Arab Emirates Afghanistan Antigua and Barbuda Anguilla Albania Armenia Netherlands Antilles Angola Antarctica Argentina American Samoa Austria Australia Aruba Azerbaijan Bosnia and Herzegovina Barbados Bangladesh Belgium Burkina Faso Bulgaria Bahrain Burundi Benin Bermuda Brunei Darussalam Bolivia Brazil Bahamas Bhutan Bouvet Island Botswana Belarus Belize Canada Cocos (Keeling) Islands Central African Republic Congo Cook Islands Chile Cameroon China Colombia Costa Rica Cuba Cape Verde Christmas Island Cyprus Czech Republic Djibouti Denmark Dominica Dominican Republic Algeria Ecuador Estonia Egypt Eritrea Spain Ethiopia Finland Fiji Falkland Islands (Malvinas) Micronesia Faroe Islands France Gabon Germany Great Britain (UK) Grenada Georgia French Guiana Ghana Gibraltar Greenland Gambia Guinea Guadeloupe Equatorial Guinea Greece S. Georgia and S. Sandwich Isls. Guatemala Guam Guinea-Bissau Guyana Hong Kong Heard and McDonald Islands Honduras Croatia (Hrvatska) Haiti Hungary Indonesia Ireland Israel India British Indian Ocean Territory Iraq Iran Iceland Italy Jamaica Jordan Japan Kenya Kyrgyzstan Cambodia Kiribati Comoros Saint Kitts and Nevis Korea (North) Korea (South) Kuwait Cayman Islands Kazakhstan Laos Lebanon Saint Lucia Liechtenstein Sri Lanka Liberia Lesotho Lithuania Luxembourg Latvia Libya Morocco Monaco Moldova Madagascar Marshall Islands Macedonia Mali Myanmar Mongolia Macau Northern Mariana Islands Martinique Mauritania Montserrat Malta Mauritius Maldives Malawi Mexico Malaysia Mozambique Namibia New Caledonia Niger Norfolk Island Nigeria Nicaragua Netherlands Norway Nepal Nauru Neutral Zone Niue New Zealand (Aotearoa) Oman Panama Peru French Polynesia Papua New Guinea Philippines Pakistan Poland St. Pierre and Miquelon Pitcairn Puerto Rico Portugal Palau Paraguay Qatar Reunion Romania Russian Federation Rwanda Saudi Arabia Solomon Islands Seychelles Sudan Sweden Singapore St. Helena Slovenia Svalbard and Jan Mayen Islands Slovak Republic Sierra Leone San Marino Senegal Somalia Suriname El Salvador Syria Swaziland Switzerland Turks and Caicos Islands Chad French Southern Territories Togo Thailand Tajikistan Tokelau Turkmenistan Tunisia Tonga East Timor Turkey Trinidad and Tobago Tuvalu Taiwan Tanzania Ukraine Uganda United Kingdom US Minor Outlying Islands United States Uruguay Uzbekistan Vatican City State (Holy See) Saint Vincent and the Grenadines Venezuela Virgin Islands (British) Virgin Islands (U.S.) Viet Nam Vanuatu Wallis and Futuna Islands Samoa Yemen Mayotte Yugoslavia South Africa Zambia Zaire Zimbabwe
Geburtsort/Gender*
Geburtsdatum/Date of birth *
E-Mail*
Telefon/Phon
Fax
Muttersprache/Mother tongue *
Fremdsprachen/Foreign languages
Deutsch gelernt seit/I have learned German since
Kurs vom/Course from *
Kurs bis/Course to*
Stundenzahl pro Woche/Number of hours per week	h_9 h_20 h_30 h_40
Einzelunterricht Stunden pro Tag/Privat lessons per day
andere Stundenzahl/other number of hours
Sprachniveau/Proficiency	bitte auswaehlen/please select A_1 A_2 B_1 B_2 C_1 C_2
Unterkunft vom/Accommodation from
Unterkunft bis/Accommodation to
Unterkunftsart/Accommodation type	bitte auswaehlen/please select Wohngemeinschaft/people sharing an apartment Gastfamilie/Homestay Pension Hotel andere/other
Zimmerart/room type	bitte auswaehlen/please select Einzelzimmer/Single room Doppelzimmer/double room Mehrbettzimmer/multiple
Verpflegung/Board	bitte auswaehlen/please select keine Verpflegung/no board Fruehstueck/Breakfast Halbpension/Half board Vollpension/Full board
Ihre Fragen/Your questions
* Pflichtfeld