First Name

Family Name

How would you like to communicate? - E-mail Fax Post

Home address (in your country) or contact adress (if different)

Address

City

Country

Post/Zip code

Telephone

Fax

E-Mail

Please give the details of who to contact in an emergency

Name

Telephone

Fax

E-Mail

Relationship to you

Gender - Male Female

Date of birth (dd/mm/yyyy)

Occupation

First language

Nationality

Any medical condition(s) which the School needs to know about?

Why do you want to study English?

How did you hear about the Eckersley Oxford

Name of the course

Hours per week - 15 21

Start date (dd/mm/yyyy)

Finish date (dd/mm/yyyy)

Number of weeks

Are you a beginner in English? - Yes No

If you would like to take an exam please indicate which one - FCE CAE IELTS Other

Passport number

Visa type

Date of Visa expiry (dd/mm/yyyy)

If you have booked your flight please write the details here:

Airport

Terminal

Date

Arrival time

Flight number

Date

Departure time

Flight number

Do you want the School to arrange taxi transfer from the airport to Oxford ? - Yes No

Do you want the School to arrange taxi transfer from Oxford to the airport ? - Yes No

If you are studying for at least 15 hours a week and would like the School to arrange accommodation for you, please complete this part of the form. If you do not require accommodation, please select the option in Accommodation type below.

Arrival date at accommodation (Sunday - dd/mm/yyyy):

Departure date from accommodation (Saturday - dd/mm/yyyy):

Do you have any allergies or dietary requirements?

What are your hobbies or interests?

Please give any other information that could be useful to the Accommodation Manager:

Payment. We will only arrange accommodation when we have received the deposit and registration fee. The accommodation fee must be paid in full to the School not later than 7 days before the start of your course.

Your accommodation will be reserved from the Sunday before your course begins until the Saturday after it ends. You will be charged for complete weeks, but your last week will be 6 nights.

Send this application form together with a Registration Fee (65 GBP) and a Deposit (200 GBP) to confirm your enrolment and to book your accommodation. We will send you a Certificate of Enrolment and a statement of the fees to be paid. If we cannot accept you for the course you want to do, we will return your deposit and registration fee.

Please choose a method of payment. Cheque, bank transfer or credit card.

Please make sure that your name appears on the transfer document. Please pay all bank charges. If charges are deducted in Britain, we will ask you to pay them when you arrive.

Please note that this is not a secure site. You may prefer to give us your card details on the phone, via fax or email.