| Personal
Details ... |
Family
Name
(Mr. Mrs. Ms.): |
|
| First
name(s) : |
|
| Nationality
: |
|
| Date
of Birth : |
|
| marital
status : |
single
married |
| Profession
: |
|
| Home
address : |
|
| Tel(home)
: |
|
| Mobile
: |
|
| E-mail
: |
|
| Business
address : |
|
| Tel(business)
: |
|
| Fax
: |
|
| Course
Details ... |
| Which
school/college/univercity would
you like to attend: |
|
| Which
course applying for : |
|
| How
many hours per weeks : |
|
| Starting
date : |
|
| Finishing
date : |
|
| How
would you estimate your own
English level : |
Beginner
Elementary
Intermediate
Higher intermediate
Advanced |
| If
yes , which exam did you take
: |
|
Accommodation
Details ... |
| What
kind of accommodation would
you reqiure: |
Host
Family
Self Catering
Executive Family (when
available)
Campus (when available) |
| If
you stay with family : |
| Would
you prefer living with a family
with pets : |
|
| Would
you prefer living with a family
having children : |
|
| Would
you prefer living with with
smokers : |
|
| Is
there any food that you cannot
eat : |
|
| Do
you have any conditions that
we should know about : |
|
| Do
you have any special requirements
: |
|
To the best of
my knowledge, all the information
I have given is correct. I am
over 18 and I accept the terms
and conditions of Inter-con(UK)
|
