Application - English As You Like It - Intesive Residential English Courses

Application Form

Please complete the form to reserve your course, all fields are optional try to fill in as much as possible, then press SUBMIT. Alternatively you can phone Phil on 01638-741743 or write to him at the address at the bottom of the page.


*Student details*
First name		Sex	Male Female
Surname		Date of birth	dd/mm/yy
Nationality		Telephone no
Smoker	If so, do you agree not to smoke in tutor's house or car?
Any health problems
Dietary preferences
Email address
Address
*Next of kin details*
First name		Surname
Nationality		Telephone no
Email address
Address
*Course Details*
Arrival date		Depature date
Transfer required from		Transfer to
Hours tuition per week
*Student's knowledge of English*
Speaking		Reading
Listening		Writing
Special course requirements
*Additional Details (please describe yourself, your hobbies, interests, likes, dislikes, etc)*
About You
Submit		Clear

Phil Huffman
Providence House
Ness Road
Burwell
Cambs CB5 0DB
Tel: 01638-741743

Modified 14-Mar-2002