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Adult Registration Form
Adult Registration Form
Personal Information
Which program will you be attending?
*
Le Fetuao Samoan Language Center (Salt Lake)
Name
*
Date of Birth
Age
Ethnicty
Language(s) spoken at home
Please select how well you know Samoan:
I speak fluent Samoan
I speak limited Samoan
I do not speak Samoan
Have you attended Samoan language classes anywhere? If so, where?
Have you attended Le Fetuao SLC before?
Yes
No
If you attended Le Fetuao before, which years did you attend?
What do you want to learn at Le Fetuao Samoan Language Center?
What are you expectations of this program? (your feedback will help us a lot- FA'AFETAI)
We welcome any suggestions to improve the program. Please let us know if you have any suggestions:
Contact Information
Phone
*
Your Email
*
Home Address
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Your parents' Samoan Language Abilities
Your mother's ethnicity:
Your mother's Samoan language ability
N/A
Speaks Samoan
Speaks limited Samoan
Does not speak Samoan
Dont know
Your father's ethnicity:
Your father's Samoan language ability:
N/A
Speaks Samoan
Speaks limited Samoan
Does not speak Samoan
Don't Know
Release
Participation
*
I understand participation in this program, therefore I should attend all sessions unless there’s an emergency, I will contact school administration by calling (808) 333-6410 or email admin@lefetuao.com.
Yes
No
Photo / Video Release
*
I hereby give permission for my work, which may or may not be accompanied by my name, and/or photograph to be electronically displayed (in web pages, print, or video productions) and hereby release the Le Fetuao Samoan Language Center from any liability resulting from or connected with the publication of such work.
Yes
No
PPhoto / Video Release, Part II
*
I give consent for the Le Fetuao Samoan Language Center to take or use photos/videos of myself for commercial or non-commercial educational purposes. LFSLC will use my photos for promotional and educational purposes of the program.
Verification
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2016 Symposium Links
2016 Symposium
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