Country of Birth
City of Birth
Date of Birth
Who to contact in case of emergency during your stay in Russia
Possible arrival (dd/mm/yy)
Possible departure (dd/mm/yy)
Are you booking together with another student? (if yes, please write the name)
Do you need the visa support (an invitation letter from the school)?
*if yes, fill in item 2, please
Address and telephone number of your workplace or Name of the educational establishment
Where will you apply for the Russian visa(country, city)?
What cities in Russia are you planning to visit?
Please send the copy of your passport to the e-mail address firstname.lastname@example.org (important for getting Russian visa)
*Shared rooms are only available for two students booking together
Do you have any specific dietary requirement?
Do you have any allergies?
Guest house/hostel/hotel/Apart Hotel
Date of arrival (dd/mm/yy)
Date of departure (dd/mm/yy)
Numbers of weeks/days
Choose from the list http://www.derzhavin.com/en/pages/263/
Name of hostel
Choose from the list http://www.derzhavin.com/en/pages/265/
Name of hotel
Please write the address of staying in St. Petersburg (important for visa support)
Do you require airport transfer on arrival?
Date of arrival
Do you require airport transfer on departure?
Date of departure
Lessons per week
Start date (dd/mm/yy)
Number of week
Exam Preparatory Course
Mini group lessons
Work and study
Other course type
*Special interests of study (only for One-to-one)
How do you assess your level of Russian
Pre- Intermediate (A2)
Pre- Advanced (B2)
Previous Russian languages courses - Please indicate year of study, place of study, course length and course intensity (hours per week):
How did you find Derzhavin Institute?
Friends who have been to our school
Teachers or professors
I have already been in Derzhavin Institute
Разработка сайта: Первая Веб Дизайн Студия
We work: Mon.-Fr. 09.30 - 22.00 Phone: +7 (812) 578 53 98
Our address: Troitskij pr.6, Saint-Petersburg, Russia
курсы иностранных языков | курсы итальянского языка