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Enrolment Form
Student Number:
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Personal Details
First Name:
Surname:
Date of Birth (D|M|Y):
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Contact Details
Home Address:
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UK Telephone:
Emergency UK Contact:
UK Mobile:
Emergency UK Telephone:
Email:
Course Details
Course Requested:
Level of English:
Start Date (D|M|Y):
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Business Level:
Course Length:
Payment Details
Total Course Fees:
£
Instalment Plan:
Fees Paid:
£
£:
Due:
Paid
Registration Fee:
£
£:
Due:
Paid
Accommodation Fee:
£
£:
Due:
Paid
Accommodation Booking Fee:
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I hereby enrol myself for the above course for the period shown above and accept all Terms and Conditions.
Other:
£
Signature:
Date:
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TOTAL PAID:
£
Balance:
£
Credit Card
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Postal Order
Bank Transfer
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If you completed this form on behalf of the applicant, state:
Name:
Relationship:
Education
Dates:
Course:
Qualification Received:
Place of Study:
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Work Experience
Dates:
Job Title:
Responsibilities:
Place of Work:
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Visa Information
Do you need a Student Visa?
Yes
NO
Start Date (D|M|Y):
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Expire Date (D|M|Y):
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If you are in the United Kingdom, please confirm when you entered the country?
Have you studied in the United Kingdom before?
Yes
NO
Place:
Course:
From:
To:
Requirements
Airport Pickup
Airport pickup required?
Yes
NO
Departure:
Flight:
Arrival Date (D|M|Y):
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Time:
Arrival Airport:
Terminal:
Accommodation
Accommodation required?
Yes
NO
Type of Accommodation:
Start Date (D|M|Y):
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Residential
Single
Finish Date (D|M|Y):
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or
Twin
Homestay
Triple
Disabilities
Type of Disability:
None
Special Requirements?
Yes
NO
Dyslexia
Blind/Partially Sighted
If yes, please specify:
Mobility Difficulties
Deaf/Hearing Impairment
Deaf/Hearing Impairment
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