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Month_________Day_______Year________
Global Education Office,
I (full name) __________________________, passport/ID number______________authorize
the Universidad Latinoamericana de Ciencia y Tecnología (ULACIT), to charge my credit or
debit card number______________________with expiration date_______________, the
amount of dollars $ __________________or amount in colones ¢ ____________.
The above charges are due to: _______________________________________
_____________________________
Signature
Important:
Please, enclose the following documents:
Copy of both sides of the ID or main page of the passport. Copy of both sides of the card. Please send this form thoroughly filled out to: [email protected] The information in this document may be verified at any moment during the enrollment process. Illegible forms will be sent back. We advise applicants to fill it out using Microsoft word and print it
only to be signed (this form is expected to be sent in PDF format).
