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Lewis School of English - Adult School

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Please complete the form below, save it and email it to study@lewis-school.co.uk.

Fields in grey need information to be input. You can press TAB to go quickly to the next field.

 

Personal Information
Family Name  
First Name  
Date of Birth dd mm yyyy
Gender Male Female
Nationality  
Passport Number  
First Language  
Occupation  
Level of English  
 
Contact Details
Address  
Postcode  
Country  
Telephone Mobile Home Work
Email  
 
Contact Details for Billing (if different)
Name  
Address  
Postcode  
Country  
Telephone Mobile Home Work
Email  
Relationship to student  
   
Other Information
Promotional Code If you have a promotional code, please enter it here:
Comments Please use this space for any other information you feel may be important.    

 

Course Information
Course Chosen  
Number of Weeks  
Start Date dd mm yyyy
Extra Course (if you would like 1:1 lessons or extra General English)
 
Additional Course
If you would like to start another course after the one above, fill in the section below.
Course Chosen  
Number of Weeks  
Start Date dd mm yyyy
Extra Course (if you would like 1:1 lessons or extra General English)
 
Accommodation
Type Homestay Residential (summer only) Hotel No Accommodation
For Homestay Accommodation
Homestay Type  
Shared Room? Click here if you want a shared room Name of person sharing
Smoking?  
Children?  
Pets?  
Arrival Date dd mm yyyy
Leaving Date dd mm yyyy
Full board includes packed lunch Monday to Friday. A premium of Ј10 per week applies from 16/6/13 to 18/8/13.
For Residential Accommodation
Room Type  
Catering? Self-Catering Half Board
Arrival Date dd mm yyyy
Leaving Date dd mm yyyy
 
Taxi Transfer
Would you like the school to arrange a taxi transfer to your accommodation?
Transfer on arrival Yes No On departure Yes No
Date dd mm yyyy Date dd mm yyyy
Time   Time  
Flight Number   Flight Number  
Arrival Airport   Arrival Airport  
Flying from   Flying from  

 

Health
Do you suffer from any physical or mental health problems?No Yes
If yes, please give details
Are you currently taking any medications? No Yes
If yes, please give details
Do you suffer from any allergies? No Yes
If yes, please give details
Do you have any special dietary requirements, eg vegetarian, Muslim, vegan? No Yes
If yes, please give details
Please give details of the person we should contact in the event of an emergency.
Name Telephone
Relationship to Student
 
Insurance
The school can arrange insurance cover for you. See www.lewis-school.co.uk/insurance for details.
Would you like the school to arrange insurance cover for you?
Length of cover (weeks) To startdd mm yyyy
 
Visa Students
UKBA Tier 4 Highly Trusted Sponsor licence no V12H0AJV2
Do you need to apply for a visa before entering the UK?
 
Further Information
I would like to receive my enrolment letter by
How did you hear about the Lewis School?
 
Agreement to Terms & Conditions
I have read, understood and agree to the Conditions of Enrolment. I agree to attend the above course.
Name Date dd mm yyyy
     

 

Thank you for your application. Please save this form and email it to study@lewis-school.co.uk. As soon as we receive your form and enrolment fee, we will confirm your place and send you an enrolment letter and an invoice.

 

Lewis Schools Ltd (trading as Lewis School of English). Registered in England, No. 03312844. Registered office: 33 Palmerston Road, Southampton SO14 1LL, UK.

 


Conditions of Enrolment

 


Please read the following conditions carefully before booking your course. Please also read our Student Selection Policy *. We reserve the right to reject an application based on this policy.

 


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