Student Application form

First Name:

Last Name:

Age:

Sex:

E-Mail:

Phone:

Address:

Town/City:

Country:

Details of Special Educational Needs:
(e.g. dyslexia, ADHD) :

Details of Medical Conditions:
(e.g. diabetes, asthma, epilepsy) :

Details of Allergies
(e.g. medication, anesthetics, nuts) :

Course Start Date:

Course Finish Date:

Course Code:
GE1GE2GE3OtherAY (Work & Study)AY (Afternoons)

If Other please specify:

Level of English:
—Please choose an option—Introduction 1 (age 3-4yrs)Introduction 2 (age 5-6yrs)BeginnerElementaryPre-IntermediateIntermediateUpper-IntermediateAdvanced

Introduction 1:
For Children aged 3-4 years

Introduction 2:
For Children aged 5-6 years

Beginner:
I don't speak or understand any English

Elementary:
I can say a few basic things & understand short simple conversations

Pre-Intermediate:
I can understand simple conversations & can speak a little (with mistakes) on most every topics

Intermediate:
I can speak quite well on most topics and understand the general sense of most everyday conversations

Upper-Intermediate:
I still make some mistakes but I can speak quite quickly and confidently on most topics

Advanced:
I can understand even complex topics and speak fluently with a few mistakes

Accommodation Type:
Host FamilyHotelSelf CateringI will arrange my own

If arranging your own accommodation please advise where you will stay:

Do you wish to be collected :
—Please choose an option—YesNo

Arrival place :

Flight No :

Date :

Time :
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Do you wish to be dropped off when you finish :
YesNo

Departure place :

Flight No :

Date :

Time :
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Name :

Relationship (e.g. parent, spouse) :

Phone :

E-mail :