English course application

Name:      

Nationality:

Age:         

Occupation:

Email address:

Area in England: North West Only Manchester Liverpool Chester Preston Blackpool The Lake disctrict

Hours per week tuition required: 15 20 25 30

No. of weeks required: 1 2 3 4 5 6 7 8 9

Dates:

January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

List here any specific requirements you may have - eg. vegetarian, business designed course etc

Hobbies and interests:

I am a smoker: yes no

I would like a transfer from the airport on arrival:

Manchester Liverpool Other