Bristol Language Centre

English School Bristol – 1st Floor, 3 Portwall Lane Redcliffe, Bristol BS1 6NB
t: +44(0)117 929 2233
f: +44(0)117 929 2234
email
Link to map

Application Form

I have read and understood the Additional Information
All fields marked with an * must be completed.

* Yes

PERSONAL INFORMATION

Title*

First Name (s)*

Family Name*

Date of Birth*

Nationality*

Occupation*

Address home*

Postal Code*

Country*

Telephone*

Fax

Email*

COURSE DETAILS

Course name*

Is the course*

full time morning or part time

Course start date*

Course end date*

Total length of course

Please indicate your
level of English*

Elementary Pre-intermediate Intermediate
or Advanced

How long have you been learning English?*

Please let us know of any English Language exams you have taken and results. For example IELTS

ACCOMMODATION

Do you require homestay accommodation?

Yes No

Please note that accommodation is usually booked from Sunday to Saturday. If you require any extra nights' accommodation, these will be charged at a rate of £13.00 per night.

Arrival Date*

Departure Date*

Do you smoke?*

Yes No

If yes, can we place you
in non-smoking accommodation?

Yes No

Please let us know if you have any medical conditions, allergies or special dietary requirements*

FLIGHT DETAILS

Do you require a
transfer from the airport?*

Yes No

Arrival airport*

Flight number*

Arriving from*

Arrival time*

PAYMENT

How do you intend to
pay your deposit?*

Bank draft bank transfer credit card

Credit card:

I will let you have my card details by

email fax telephone

*Please note that a deposit must be made within 7 days of application in order to confirm your place

OTHER

How did you find out about the school?

If other, please give details

Anything else you think we should know

Enter Security Code:

If you have any further questions or wish to apply by another method, please do not hesitate to contact us and we will be happy to help.