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
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 22
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
Departure time
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.
Accommodation type
Homestay
Help us to choose the right family for you by answering the following questions: We will try to meet your requirements.
Do you smoke? - Yes No
If you don´t smoke, would you accept a family where people smoke? - Yes No
Would you accept a family with young children? - Yes No
Would you accept a family with a pet (dog, cat, bird, etc.) - Yes No
Type of room - Single room Shared room
Please note: Dover House is a non-smoking house
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 4 weeks 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 Deposit of 300 GBP to confirm your enrolment and to book your accommodation. We will send you an Acceptance letter 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.
Please choose a method of payment. Cheque, bank transfer or credit card.
HSBC 65 Cornmarket Street, Oxford, OX1 3HY Sort Code: 40-35-34 Account: 62751038 Swift code: MIDLGB22 IBAN Number: GB64MIDL40353462751038
Please make sure that your name appears on the transfer document. Please pay all bank charges.
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.
Credit card type: - Visa Mastercard jcb
Expiry date
Card number
Debit from my account 300 GBP Registration Fee and Deposit.
Debit from my account the balance of tuition and accommodation fees 4 weeks before the start of my course (We will confirm the amount when we receive this form).
Person or organisation paying the fees - Myself Parent Other
I accept the Terms and Conditions. I agree to pay the rest of the fees not later than 4 weeks before the start of my course (For students under 18 years old, a parent or legal guardian should sign).
Copyright © 2007 Eckersley Oxford All rights reserved. 14 Friars Entry, Oxford, OX1 2BZ, England Tel: +44 (0)1865 721268 Fax: + 44 1865 233 968 email: english@eckersley.co.uk
