Family name*:        First name(s)*:   [Please enter your name as in your passport.]

Age (minimum age 16)*:        Date of Birth [DD/MM/YYYY]*:       Gender*:   Male Female

Nationality*:       E-mail*:

Telephone (Emergency contact) :   Mobile: Fax:

Address:   [Street]*     [Number]     [City]*

[Region / Province]       Postal code   [Country]*  

English language level: Beginner Elementary Pre-Intermediate Intermediate Upper-Intermediate Advanced Proficiency  

How long have you studied English?  < 6 months 6-12 months 1-2 years over 2 years                                   [Test your level online here]

Start date*

2012/01/03 2012/01/09 2012/01/16 2012/01/23 2012/02/30 2012/02/06 2012/02/13 2012/02/20 2012/02/27 2012/03/05 2012/03/12 2012/03/19 2012/03/26 2012/04/02 2012/04/09 2012/04/16 2012/04/23 2012/04/30 2012/05/07 2012/05/14 2012/05/21 2012/05/28 2012/06/04 2012/06/11 2012/06/18 2012/06/25 2012/07/02 2012/07/09 2012/07/16 2012/07/23 2012/07/30 2012/08/06 2012/08/13 2012/08/20 2012/08/27 2012/09/03 2012/09/10 2012/09/17 2012/09/24 2012/10/01 2012/10/08 2012/10/15 2012/10/22 2012/10/29 2012/11/05 2012/11/12 2012/11/19 2012/11/26 2012/12/03 2012/12/10 2012/12/17 2012/12/24       End Date* 2012/01/08 2012/01/15 2012/01/22 2012/01/29 2012/02/05 2012/02/12 2012/02/19 2012/02/26 2012/03/04 2012/03/11 2012/03/18 2012/03/25 2012/04/01 2012/04/08 2012/04/15 2012/04/22 2012/04/29 2012/05/06 2012/05/13 2012/05/20 2012/05/27 2012/06/03 2012/06/10 2012/06/17 2012/06/24 2012/07/01 2012/07/08 2012/07/15 2012/07/22 2012/07/29 2012/08/05 2012/08/12 2012/08/19 2012/08/26 2012/09/02 2012/09/09 2012/09/16 2012/09/23 2012/09/30 2012/10/07 2012/10/14 2012/10/21 2012/10/28 2012/11/04 2012/11/11 2012/11/18 2012/11/25 2012/12/02 2012/12/09 2012/12/16 2012/12/23 2012/12/30

Course*: Main Course Main Course with Options Main Course with IELTS Foundation IELTS Preparation English for Professionals Standard English for Professionals Intensive

Will you need accommodation? Yes No    

If yes:    Do you smoke? No Yes

If you smoke, are you happy to stay with a non-smoking host family? Yes No

Do you have special accommodation requests? No Yes

If yes, please specify:

If yes, please specify:

IMPORTANT! Please read carefully.

If you are from outside the European Union, under the current UK visa system, you will probably need a visa to study in the UK. Please choose one of the 3 options shown:

1. If you will study for up to 6 months you can apply for a Student Visitor Visa (SVV).

2. If you intend to study English language for 6 – 11 months you can apply for an Extended Student Visitor Visa (ESVV).

3. If you already have a good level of English and have a "Secure English Language Test" (SELT) certificate (for example, IELTS at 4.5 or higher with each individual component 4.0 or above) you may apply for a General Student Visa (GSV) for any period. This allows you to extend your stay or change schools while in the UK.

When you are sure which visa you require, if any, please continue:

If you are applying for a visa, please choose which visa you need: GSV SVV ESVV None

We need a copy of the passport for all visa applicants. Send it by email to enrol@cesc.co.uk or fax to +44 1206 761489

Do you need a Confirmation of Acceptance for Studies (CAS) to apply for a GSV? No Yes You must send a copy of your SELT certificate by email or fax.

Would you like us to arrange a taxi from / to the airport? No Yes

If yes, please complete the following:

-- Arrival airport -- Stansted Luton Gatwick Heathrow         Terminal  Date [YYYY/MM/DD]  Flight   From  Time 

-- Departure airport -- Stansted Luton Gatwick Heathrow  Terminal  Date [YYYY/MM/DD]  Flight    To     Time