Enrolment Form: The Language Centre - 2017/18 Esol Programme

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THE LANGUAGE CENTRE – 2017/18 ESOL PROGRAMME

Enrolment Form

Registered Community Interest


Company nb 8613938

Please return a signed copy of this application form, with your payment, to:
THE LANGUAGE CENTRE (CIC), General office- 6, Old Eldon Square (3rd floor), Newcastle upon Tyne, NE1 7JG

I would like to apply for:


Course name and number
Course name and number
Online user ID number

Your details
First name: Title (Mr.Mrs.Miss.Ms.Dr.Pr)
Surname:
Address:

Town: Postcode
Home tel number: Mobile:
E-mail address:
Gender : Male Female
Date of birth: Nationality:
Mobile number of Person to contact in an emergency:
Your Highest Academic Qualification (GCSE, A-Level, Degree...):
Your first language (mother tongue):
Disability (we will not disclose this information to anyone unless you give us permission)
Do you have a medical condition, disability which you feel we should know about? Please provide full name and
details of your condition. Please note that the TLC general office and rooms in Old Eldon Square do not have
disabled access.

Would you like us to pass on this information to your tutor?


Ethnic Origins (for statistical purposes)

White British Black British Asian British Arab


White Irish Black African Indian/ Pakistani Prefer not to say
White-other Black- other Chinese
Mixed British Mixed non-British Other Asian

Fee for various courses (non-residential)


ENGLISH standard 30 hours INTENSIVE ENGLISH 25 hours Specialist ESOL Course 15 hours
course course
£264 £220 £132

Payment methods
You can pay for your course On-line:

1. By all major debit/credit cards using WorldPay at checkout.


2. By making a bank transfer to:
THE LANGUAGE CENTRE (CIC)
Unity Trust Bank
Sort code: 608301
Account: 20332127
Please send us an e-mail with your enrolment form and details of your transaction.

3. By cash or cheque: (Cheques should have your name and address printed clearly on the back. Please make
payable to The Language Centre (CIC), and send to or visit:

THE LANGUAGE CENTRE (CIC)


6, Old Eldon Square (3rd floor)
Newcastle upon Tyne, NE1 7JG

(We will not disclose any personal information to anyone unless you give us permission)

How did you hear about The Language Centre?

Prospective students should consider their circumstances very carefully, and whether they have enough time to
dedicate to learning a language in addition to their academic workload and/or other commitments. The refund
policy applies in all cases, and refunds due to exceptional circumstances which arise after enrolment are at the
discretion of the director of TLC

Student’s signature: Date:

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