ACCEPTANCE LETTER APPLICATION FORM

Send your passport scanned (only photo page) and the completed form (all fields) to ac.celin.ufpr@gmail.com:
01- Full name (as per passport, do not abbreviate or omit any name) - First name/ Middle name / Last name
02- Place of birth (city/state/country)

03- Date of birth (day/month/year)

04- Marital status

06- Sex: ( ) female ( ) male

07- Passport number

08- Issuing country:

09-Expiration date (D/M/Y)

10- Parents full name (First name/ Middle name / Last name)
Fathers name:
Mothers name:
11- E-mail address:
12- Phone Number (country code + city code + number):
13- Emergency contact numbers (numbers and names-relationships):
14- Permanent address (home) :
15- Academic education (course):
Year of completion:
Institution :
City/Country:
16- Knowledge of foreign languages: 1-Fluent 2-Intermediate 3-Advanced 4-Basic
( ) English ( ) French ( ) Spanish ( )German ( ) Other________________
17- Professional information:
Area of work:
Work address:
18- First time in Brazil: ( ) No

Company/Institution :
Phone Number:
( ) Yes - Places visited:____________________

Function:

19- Have you ever studied Portuguese before: ( ) No ( )Yes How long (hours/course)?__________
20- Why have you decided to study Portuguese?
21- How long do you want to study Portuguese at Celin? ( ) 02 months ( ) 06 months ( ) 08 months ( ) one year
22- How did you get to know about the Portuguese as a Foreign Language Course at Celin?
(
(
(
(

) Friends
) Internet
) Academic exchange program
) Exchange Language Program Agency/ agent

University name_________________
Agency/ agent name:____________ Phone number:_________

R. XV de Novembro, 1441 Centro Curitiba/PR CEP 80.060-000

Fone: +55 41 3408-7812 E-mail: ac.celin.ufpr@gmail.com Site: www.celin.ufpr.br

23- Portuguese course tuition fees:

Payment methods: Payment of tuition fees in Brazil must be in Reais, Brazilian currency. International payment
must be done in U.S. Dollars or in Euro.

- Tuition fees payment has to be done directly to the Federal University of Paran bank account.
- International wire transfer to Federal University of Paran bank account.
CELIN does NOT accept: Cash payments, personal checks, debit card or credit card payments, money orders or
cashier checks made out in foreign currency.
Celin doesnt charge any extra fees not mentioned in this contract.
Payment
Modules

Duration of the course

Workload

Cost (Real)
Brazilian currency

August 10 to September 29 2015

90h

R$1.050,00

II

October 13 to December 08 2015

90h

R$1.050,00

Placement test fee

R$20,00

Acceptance letter fee (notary public fee and post office/sedex

international express service )
or
Acceptance letter fee (notary public fee and post office/ sedex
national express service)
Total in the Brazilian currency (Real)

R$200,00
delivery)

Subtotal in US Dollars: conversion will be made by using the

average exchange rate of US Dollar published by Central Bank of
Brazil. http://www4.bcb.gov.br/pec/taxas/batch/taxas.asp?id=txdolar

(overseas

R$70,00 (delivery
Brazil)
R$xxxxx,xx
Conversion
will be
made by
date

Transaction fees (international bank charges) updated amount on

08/05/15 (if payment)
Total in US dollars

in

US$xxxx,xx

US$50,00
US$xxxx,xx

- Course books are not included.

Signature and date - please copy the following statement in the space provided, use handwriting.
I hereby affirm that I have read, understood, and agreed with the terms of the Tuition fees policy .
_______________________________________________________________________________________________
______________________________________________________________________________________________
Date: ___________________ Signature:________________________________________________________
(day/month/year)

R. XV de Novembro, 1441 Centro Curitiba/PR CEP 80.060-000

Fone: +55 41 3408-7812 E-mail: ac.celin.ufpr@gmail.com Site: www.celin.ufpr.br