| About you ... |
| Last name:
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First name(s):
 |
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| Nationality: |
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Sex: |
Male
Female |
| First Language: |
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Date of Birth: |
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| Occupation: |
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Age: |
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| Home address: |
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| Phone: |
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Fax: |
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| Mobile: |
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E-mail: |
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| Address for invoice: |
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| Phone: |
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Fax: |
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| Mobile: |
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E-mail: |
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Level of English?
(3 = Lower Intermediate, 4 = Intermediate, 5 = Upper Intermediate,
6 = Advanced) |
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Reading:
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Listening:
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Writing:
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Speaking:
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| Name of University/College
attended: |
Type of qualification:
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| Number of years studied: |
Date of graduation: |
England experience:
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English qualifications:
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Previous work experience:
(Include dates, your position and the type of work done by
the organisation(s) you have worked for)
|
List your computer skills:
|
Explain the work experience you
would prefer:
|
| Individual requirements: |
Number of weeks language development
(N.B. Minimum of two weeks language development) |
Number of weeks work experience
(N.B. Minimum of three weeks work experience to qualify for UCLES
certifications) |
| Type of Language Development
course: |
General
English (25 hrs per week in international classes)
Group Six (25
hrs per week in small classes)
Group Six Business (25
hrs per week, small classes, focus on Business English)
One-to-One
(Alternative language courses can be structured, please contact Concorde
International prior to enrolment to discuss specific needs) |
Please list any special English
language needs:
|
Please list any special business
needs:
|
| Dates of course: |
| Start date: |
End date: |
Number of weeks: |
| Do you need accommodation? |
Yes
Standard
Host Family
Executive
Host Family |
Yes,
other. (Please specify)
|
| Do you smoke? Yes,
No | Is it OK to
be with a family who smoke? Yes,
No |
Do you like ...
Young children? Yes;
No
| Dogs? Yes;
No
| Cats? Yes;
No |
| About your health ... |
| Do you suffer from: Asthma,
Hay fever, Diabetes,
Epilepsy, other: |
| Do you need Escort Service? |
Yes
Arrival
only
Arrival
& Departure
from
London Gatwick (LGW)
from
London Heathrow (LHR)
from
London Stansted (STN)
from
Please tell us your flight details as soon as possible: |
Nein
Please tell us what time you think you will arrive at your accommodation:
From Escort
Service from/to Seaports or Ashford International (Eurostar) or train
and coach information, please ask for a price.. |
| Who told you about Concorde
International? |
| A
friend/relative |
An
agent |
the
British Council |
Other |
| Method of payment ... |
| by
bank transfer |
by
Sterling cheque on an English bank |
by
credit card
Visa / Mastercard |
|
Please read this carefully
before you submit.
I accept the Conditions
of Booking outlined on this enrolment form and enclose
payment of £100 deposit, or a copy of the transfer document. I will
ensure that payment of the total course fees is made at least 30 days
before the course begins or, in the event of late booking, prior to
arrival. |
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