Book Now – In School Face to Face Registration Form 1. Basic Information TitleSelect valueMrsMsMissMrDrProf Surname/Family Name (as on your passport)* First Name(s) (as on your passport)* Gender*MaleFemale Date of Birth (Under 18s must complete a consent form - Our Admissions Team will send you this)*2. Contact Information Address (in home country)* Post Code Telephone Mobile Number Email Address* Nationality* First Language Religion Passport Number* Passport Expiry Date*3. Emergency Contact Emergency Contact Name* Emergency Contact - Telephone Emergency Contact - Mobile Number Emergency Contact - Email Address* Who is paying your fees? (You/Family/Embassy/Other)* Your knowledge of English Beginners should start within 3 weeks of the new term to facilitate an easier start to the course.*Beginner (A1)Elementary (A1-A2)Pre-Intermediate (A2-B2)Intermediate (B1-B2)Upper Intermediate (B2)Advanced (C1) How did you hear about Liverpool School of English? Start Date (Monday)* End Date (Friday)* Number of Weeks* General English152125106 Please, choose from the following electives: *If General English 21, 25 or 6, please choose from the following electives.English for BusinessLive LiverpoolAcademic SkillsCommunication Skills IELTS with General EnglishIELTS 23 (GE 15 + IELTS 8)IELTS 21 (GE 6 + IELTS 15) IELTSIELTS 15IELTS 8 Cambridge EnglishB2 - First Exam PreparationC1 - Advanced Exam Preparation Teacher Training and Development (Age 18+) *Our Admissions Team will send you a supplementary application form for these coursesTrinity CertTESOL*TKT (Teacher Knowledge Test)*TKT Module 1TKT Module 2TKT Module 3CLIL Occupational English TestOET 10OET Exam Ready Individual 1:1sIndividual Lessons (1:1) What would you like to focus on? Other What type of accommodation do you need?*HomestayResidenceNone If 'none', please supply your UK address Street Address City Region Post Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe CountryArrival Information Arrival Date (Sunday) Departure Date (Saturday) Number of weeks Extra nights required?YesNo Saturday ArrivalSaturday Arrival Sunday DepartureSunday DepartureOther Requirements Other requirements Do you have any allergies?YesNo If yes, what? Do you take any medicationYesNo If yes, which? Do you have any dietary requirements? (e.g. Coeliac, gluten free, dairy free, etc.)* *Homestay Only - Students with extra dietary requirements will be charged an extra £30 per week Do you smoke?YesNo Homestay Only - Are you happy to live with pets?YesNo Do you want us to book an airport transfer for you?YesNo If 'yes', please tick belowArrivalDeparture Which airport will you arrive at?ManchesterLiverpoolLondon Airport(s) (price upon request)If you have booked your flight, please write the details below: Airline Flight Reference Landing Time *Students who arrive to their accommodation between 23:00 and 7:00 will be charged a £50 late check-in fee. Do you require a visa?*YesNo Already have a visa (please provide the name of your visa) Which visa do you require?Standard Visitor Visa (up to 6 months)Short Term Study Visa (up to 11 months) Other (please state) What will you do after you finish your course? Student reference number Name of your supervisor at the embassy Supervisor's email address Supervisor's telephone numberIf you are not a sponsored student, please click ‘Next’ to finish the formYou must purchase suitable travel insurance in your home country and email a copy of your policy to our Admissions team before you travel. Policy number Insurance CompanyI confirm the information given in this form is correct.I agree to the terms and conditions as displayed here: www.lse.uk.net/terms-conditions Signature* Date* I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above.*You can pay your £60 registration fee via Flywire - visit www.lse.uk.net/pay-your-feesSubmitResetThe details provided in this registration form will be stored by Liverpool School of English on its administrative systems, whether on paper, computer, or any other medium, and will be used for Liverpool School of English’s purposes only. All personal details and any other information provided to Liverpool School of English will be processed in accordance with the provisions of the relevant national legislation (with particular reference to the Data Protection Act 1998) and relevant data protection authorities. Liverpool School of English will not supply any personal information provided by applications to any third parties unless necessary to provide services requested, or perform Liverpool School of English marketing activities. It is the student’s responsibility to keep Liverpool School of English informed of any changes to their contact details for the entire length of their course.
