Name *
Name
Address *
Address
Phone *
Phone
Indicate where did you learn it and how long have you been speaking it.
What is your highest level of education? *
Oral proficiency in English shall be determined by one or more of the following. Check all applicable for English
Oral proficiency in Spanish shall be determined by one or more of the following. Check all applicable for Spanish Language
* Evidence of supporting documents (Diplomas or Certificates, CV and/or Test results) MUST be submitted in order to be accepted in the program.
***For more information on Oral Proficiency Exams or to schedule an exam you may visit Language Testing International at: www.languagetesting.com
Appendix A: Validated Third Party exams
Each test listed contains the minimum grades required. Check more than one if needed
DECLARATION OF TRUE AND ACCURATE INFORMATION I, the undersigned, declare that the information I have provided on this form is true and accurate. I understand that this information will be used to determine my eligibility for the Medical Interpreter training program. I further understand that if any of the above information is found to be false, I will be liable for payment and may be subject to termination from the program. I understand that MedTalk training has the right to request copies of certificates, diplomas, licenses or test results from validated third party entities. *