Program Application

Summer 2024 in Florence
with the Coast Community College District

Program space is limited. Students should complete this application and submit the $250 non-refundable first payment as soon as possible. Upon receipt of your application and first payment, Accent Global Learning and Coast Community College District will send you additional application and enrollment forms.

Applications must be received by March 28, 2024. Beyond March 28, limited enrollment is allowed, but only when space permits and first and second payments have been received by the Accent U.S. Office.

Participant Information
Name*
First Last
Email*
School Attending*
Year in College*
Please describe:*
Major
Current Address*
Street Address Address Line 2 City State ZIP Code
How long can you be reached at your current address?
Permanent Address
- Same as Current Address
*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Other Phone
Description of other phone:*
Country of citizenship*
Age*
Participants must be 18 years or older at the time of application.
STOP! - you must be 18 years of age or older to submit this application. If you will be 18 years old prior to the program start date please contact Accent Global Learning at info@accentglobal.com.
Date of birth*
MM slash DD slash YYYY
Sex*
We require this field because one of the many ways we use this information is in communication with the U.S. Embassy in Europe. Please make sure the sex you provide here is the same as what is listed on your passport (or will be if you do not already have a passport).
- Female
- Male
- Unspecified or another gender identity
Add gender information:
If you would like to tell us more about your gender identity please complete this field. The entire Accent team is committed to making sure every participant feels safe, welcome and respected.
How did you hear about this program?*
Please be as specific as possible.
Signature*
In signing this application I certify that I have carefully read the online program brochure for the Summer in Florence program and wish to apply. I agree to the terms and conditions stated therein, including the payment and cancellation policies. I understand that if there are any changes in the terms and conditions, Accent Global Learning will notify me in writing. The applicant shall be the client of Accent for all purposes.
First Last
Date*
MM slash DD slash YYYY
Electronic Signature*
- By checking this box, I certify that I am signing this application with Accent Global Learning electronically, that I am 18 years of age or older and agree to the terms listed above. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.
Payment Information
Program applications require a non-refundable first payment of $250 in order to be processed.
Payment Method*
Payment Instructions
Billing Address*
Street Address Address Line 2 City State ZIP Code
Billing Phone*
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Non-Refundable First Payment
Price:
In submitting this non-refundable $250 first payment to Accent Global Learning you confirm and agree to the cancellation policies described in your online program brochure and/or Accent Global Learning materials. The program participant shall be the client of Accent for all purposes.
Payment via Check
If you are unable to submit the non-refundable $250 first payment via credit card, you can mail a check to:

Accent Global Learning
2560 Ninth Street, Suite 315A
Berkeley, CA 94710

IMPORTANT: Your application will remain pending and you will NOT be considered a participant on the program until the payment is received. You will receive an email from Accent when your check has been received and you have been added to the program. If you have any questions please contact the Accent U.S. Office at info@accentglobal.com or 341.333.0544.
Phone
This field is for validation purposes and should be left unchanged.

Program Application

Participant Information

Payment Information

Payment Instructions

Payment via Check