please write in capital letters - London International Study Centre
PHOTOGRAPH APPLICATION FORM PLEASE WRITE IN CAPITAL LETTERS ACADEMIC SUBJECT COURSES: EAT INTENSIVE ENGLISH COURSE EAT IGCSE COURSE EAT A LEVEL COURSE START DATE: END START: PREPARATORY COURSE 2. SUBJECT CHOICE (please tick the appropriate boxes) SUBJECTS TO CHOOSE FOR ACADEMIC SUBJECT COURSES Please choose 4 subjects from the list below according to your course. SUBJECTS maths further maths chemistry physics law economics business studies politics and government English French German Spanish Latin Russian Chinese Italian psychology sociology information technology history geography religious studies drama media elementary upper intermediate pre-intermediate advanced LEVEL OF ENGLISH total beginner intermediate Results of any English qualifications/examinations taken, with names, dates and grades: _______________________________________________________________________________________ 3. PUPIL INFORMATION (please write in capital letters) student’s surname: __________________________ first name:_____________________________ known as: _________________________________ gender: male nationality: ________________________________ date of birth: ____ / ______ / _____ female languages spoken: ___________________________________________________________________________ London International Study Centre Ltd 2010 E-mail: contact@londonisc.com Web: www.londonisc.com 392-394 Ewell Road, Surbiton, KT6 7BB, United Kingdom Tel: +44 (0) 20 8390 8810 Fax: +44 (0) 20 8390 4775 1 student’s address: _________________________________________________________________________________ _________________________________________________________________________________ tel: _____________________________________ fax: _____________________________________________ e-mail: __________________________________ mobile: _____________________________________________ VISA APPLICATIONS ONLY passport number: ____________________________ place of issue: ___________________________________ date of issue: ________________________________ expiry date: _____________________________________ How did you hear about London International Study Centre? ______________________________________________________________________________________________ ADDITIONAL INFORMATION If there is any additional information about your son/daughter that would be useful for LISC to know, please give the details below: (e.g. personality, hobbies) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ How long is your son/daughter going to study in the UK? ______________________________________________ Will you need our help in school/college/university selection for your son/daughter in the future? YES/NO (please circle) If yes, please provide more details: ________________________________________________________________ TRANSPORT Your son/daughter may travel by any form of public transport: alone with an adult with another student With the permission of LISC personnel my child may travel in a motor vehicle driven by an adult with a valid driving licence and motor insurance (It is important to tick this box if you wish the host family to be able to carry your child in their car) OVER 14 ONLY (subject to the permission of the host family) My child may go out alone during daylight hours S/he may travel away from the local area with friends of the same age or older during daylight hours S/he may travel alone on local transport OVER 16 ONLY My child may travel alone outside the local area S/he may go out in the evening either alone or with friends S/he should return in the evening to the host family by ________ (please state time) MEDICAL INFORMATION Does your child suffer from any medical issue, illness, allergy or injury? ___________________________________________________________________________________________________ Does your child have any special dietary requirements? ___________________________________________________________________________________________________ London International Study Centre Ltd 2010 E-mail: contact@londonisc.com Web: www.londonisc.com 392-394 Ewell Road, Surbiton, KT6 7BB, United Kingdom Tel: +44 (0) 20 8390 8810 Fax: +44 (0) 20 8390 4775 2 4. FAMILY INFORMATION (please write in capital letters) father’s first name: _______________________ father’s surname:___________________________________ profession: address (if different from the pupil): ____________________ ______________________ ___________________________________________________________________________________________________ business tel: ______________________________ home tel: ______________________________________________ business fax: ______________________________ home fax: ______________________________________________ mobile: __________________________________ e-mail: _________________________________________________ mother’s first name: _______________________ mother’s surname:____________________________________ profession: ______________________ address (if different from the pupil): ______________________ __________________________________________________________________________________________________ business tel: ______________________________ home tel: _________________________________________________ business fax: ______________________________ home fax: ________________________________________________ mobile: __________________________________ e-mail: __________________________________________________ Who should be contacted in case of EMERGENCY (please tick as many as necessary): father mother both other (If other, please give name and contact details): __________________________________________________________ _________________________________________________________________________________________________ 5. PREVIOUS RECORDS (please write in capital letters) Previous schools, with dates: _________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Has the student ever been asked to leave any of the previous schools – if so, please briefly describe the circumstances:_________________________________________________________________________________ _____________________________________________________________________________________________ Is there any evidence or family history that the pupil has any learning difficulties or special educational needs: ___________________________________________________________________________________________ (Please note that this information will not effect a successful outcome of your application.) London International Study Centre Ltd 2010 E-mail: contact@londonisc.com Web: www.londonisc.com 392-394 Ewell Road, Surbiton, KT6 7BB, United Kingdom Tel: +44 (0) 20 8390 8810 Fax: +44 (0) 20 8390 4775 3 6. STUDENT'S STATEMENT (to be completed by STUDENT with NO help) NAME OF STUDENT:___________________________________________________________________ a. If you can, please write about yourself, your family and friends, your education and work experience your interests and hobbies. Please do not worry if you are unable to do so! We are here to help you with your English! We are confident you will be able to complete this section at the end of the course! b. If you can, please write what you would like to do in the future. London International Study Centre Ltd 2010 E-mail: contact@londonisc.com Web: www.londonisc.com 392-394 Ewell Road, Surbiton, KT6 7BB, United Kingdom Tel: +44 (0) 20 8390 8810 Fax: +44 (0) 20 8390 4775 4 7. CHECKLIST FORM SECTIONS (please tick once completed) 1. COURSE CHOICE 4. FAMILY INFORMATION 7. CHECKLIST 2. SUBJECT CHOICE 5. PREVIOUS RECORDS 3. PUPIL INFORMATION 6. STUDENT'S STATEMENT PAYMENTS (please remember these payments need to be made with an application form – by cheque, bank transfer or a card payment at ww.londonisc.com ) REGISTRATION FEE OF £100 PAID REFUNDABLE DEPOSIT PAID DOCUMENTS (please tick when attached to the application form) COPY OF PASSPORT COPY OF VISA (IF APPLICABLE) COPIES OF PREVIOUS SCHOOL REPORTS DECLARATION (We / I) confirm that, to the best of (our / my) knowledge, the above information is accurate and that (our child’s / my) admission to the centre is dependent on this being so. I confirm my child has not had help in completing the statement. I have read and accept the terms and conditions and enclose a registration fee (plus VAT) with this application form. signature of father: _______________________ signature of mother: _________________________ name in print: ___________________________ name in print: ______________________________ date: ___________________________________ date: ______________________________________ I HAVE READ AND AGREED TO LISC TERMS & CONDITIONS. (Please contact us if you need any help with calculating the total course price. Thank you.) London International Study Centre Ltd 2010 E-mail: contact@londonisc.com Web: www.londonisc.com 392-394 Ewell Road, Surbiton, KT6 7BB, United Kingdom Tel: +44 (0) 20 8390 8810 Fax: +44 (0) 20 8390 4775 5
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