2017 High School Language Program
Classes will meet for four weeks, Monday through Thursday starting on July 10th from 9 am until 2 pm each day.
Please note: This registration form is to be filled out by the student wanting to enroll. A sibling who wishes to enroll in the same class must fill out a separate form using a different email address; otherwise a spot in the class cannot be guaranteed.
Course Selection
Course *
Student Information
First Name *
Last Name *
Date of Birth (mm/dd/yyyy) *
Student's Email Address *
Confirm Student's Email Address.
Parent's Email Address *
Contact Phone *
Best Method of Contact (eg. email, phone, mail) *
Home Address (certificates will be mailed to this address upon completion of the course) *
City *
State *
Zip Code *
Name of High School *
How did you hear about the program? *
Why do you want to take this course? *
Languages Spoken at Home *
Where were your parents born? *
Where were you born? *

If applicable, please explain what kind of instruction you have had in your home language *
How often do you speak your home language? *
With whom do you regularly speak your home language (eg. grandparents, parents, siblings, friends)? *
Rate your level of proficiency
Rate your own level of proficiency in your home language on a scale from 1-5, with 1 being no proficiency and 5 an educated native speaker. Example: Student A has had no education in her home language, and has never learned to read or write. Her parents speak to each other in the language and she overhears. Sometimes she understands what they are talking about and sometimes she doesn’t, and she usually prefers to speak in English. Such a student might rate herself 2 in listening, 2 in speaking, 1 in reading, and 1 in writing. Student B went to weekend school ever since he can remember and learned how to read and write at a basic level. His parents always speak to him in the target language and he responds back in the language as well. He might rate himself 4 in listening, 3 in speaking, 3 in reading and 2 writing.
Listening *
Speaking *
Reading *
Writing *
This course does not automatically give high school credit. Granting a year of high school credit is up to the student’s high school. Please also note that although these courses are sponsored by and take place at UCLA, they are not college classes and do not have any college credit possibilities. *