Student Works Application Form

Your contact details

Full Name *

First Name Last Name

Nationality *

Phone Number

Area Code Phone Number

Date of Birth

Day Month Year

Sex

Male Female

E-mail *

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Passport Number or ID card Number

1. Course Programs to include English / Exams / or specialist

Do you need a course?

Yes No

If yes/maybe: what type of course

General English to include part time, full time or intensive Cambridge exams to include FCE/CAE IELTS Business SPECIALIST COURSE University

Start date

Day Month Year

End date

Day Month Year

Current level of English

Elementary Low Intrmediate Intermediate Upper Intermediate Advanced I don't know - send me a test!

How many hours per week do you want?

What time can you do the lessons? Also how many weeks do you want?

How much do you want to spend per week? €,£,or $?

Accommodation

Do you need an accommodation?

Yes No I am not sure yet

If yes/maybe: what room size would you like ?

Single Twin Double

En-suite

Yes No

Check-in date

Day Month Year

Check-out date

Day Month Year

Do you prefer:

Host family House/flat share

If you want a host family, do you prefer:

Room only Half-board Full-board

Do you have any allergies, or dietary needs or anything else we should know?

Do you smoke?

Yes No

Work experience program

Are you looking for a work experience?

Yes No I am not sure yet

If yes/maybe: are you interested in a paid or unpaid work program

Paid Unpaid Indifferent AU PAIR

What industry do you wish to work in?

Start date

Day Month Year

End date

Day Month Year

Are you applying for a scholarship (i.e. Leonardo or Erasmus)

Your CV (for work programs only)

Transfer in the UK

Do you require a transfer from a UK airport?

Yes No

Where in the world do you want to go?

UK IRELAND AUSTRALIA NEW ZEALAND

What city?

How did you hear about us or the name of the agent you used? *

I give permission for my details to be shared with 3rd parties such as schools or businesses that are relevant to my file.

Yes No

Signature

Clear