Wallace College - English Language Courses Application Form 2009

Note: This form is for courses beginning in 2009. If you wish to enrol for courses beginning in 2010, please click here.

How To Complete This Form

Please complete the Personal Details, Payment Details and Course Details sections, and if you require accommodation to be arranged, the Accommodation section. Use the Tab key to move from one field to the next, or click on a field to select it.
Once you have completed the form, you can send it to us by clicking on the button marked 'Send'. The button marked 'Clear' removes any entries you have made, should you wish to start again. Both these buttons are located at the foot of the form.

Personal Details
First Name
Middle Initial(s)
Family Name
Home Address
Telephone Number
Fax Number
E-mail address
Date of Birth
Nationality
Occupation
Hobbies / Interests
Sex	Male
	Female
Please give the name, address and telephone number of someone who may be contacted in the case of an emergency.
Contact Name
Address
Telephone Number
Course Details
Please indicate your current Knowledge of English
	Elementary
	Lower Intermediate
	Intermediate
	Upper Intermediate
	Advanced
Please select the course you wish to enrol for:
	English Morning Classes English Morning & Afternoon Classes English Afternoon Classes English Evening Classes (4 hrs/week) Business English IELTS 3 Week Course IELTS 10 Week Evening Course CAE 10 Week Evening Course FCE 10 Week Evening Course 5 Private Lessons 10 Private Lessons 15 Private Lessons 20 Private Lessons
Starting Date	Monday 30 November 2009 Monday 07 December 2009 Monday 14 December 2009
Finishing Date	Friday 04 December 2009 Friday 11 December 2009 Friday 18 December 2009
Number of weeks
Accommodation
Please complete this section if you would like accommodation to be arranged for you. If you have made your own arrangements please give the address and telephone number of your accommodation.
Arrival Date: (Click the icon to select a date) Departure Date: (Click the icon to select a date)
Please select the type of accommodation you would like.
	Stay with Host Family Residence Guest House Hotel Made Own Arrangements
What type of room do you require?
	Single
	Shared
Do you require
	Bed & Breakfast only
	Dinner, Bed & Breakfast
	Dinner, Packed Lunch and Bed & Breakfast
Do you smoke?
	Yes
	No
Please indicate special requirements, allergies or health problems and indicate if you are taking any prescribed medicines.
Special Requirements
Is there any food you do not eat? (e.g. Are you a vegetarian?)
Food Requirements
I have made my own arrangements for accommodation. My address and telephone number will be:
Address
Telephone Number
Transfers
Would you like to be met at the airport and taken to your accommodation? If so, please give details of the date, arrival time and flight number. We can also arrange for you to be taken to the airport on departure.
	No
	On Arrival Only
	Both Arrival and Departure
Flight Number
Arrival Time*
*Please use 24 hour clock, e.g. 9:30 pm = 2130
Payment Details
Course Fee
Accommodation
Transfers
Total
Please read the conditions of enrolment (at the bottom of this form) and click the check box below.
I have read and agree to the conditions of enrolment printed below
Note: Please make sure that you click the Send button only once, otherwise we will receive multiple copies of your application.

Conditions Of Enrolment

(a) The cancellation of a course by you:
(i) more than two weeks before the start of the course: Full refund less an administration fee of £50.00.
(ii) less than two weeks before the start of the course: No refund.
b) Once a course has commenced, lessons cannot be postponed, assigned or refunded for any reason.
(c)Wallace College reserves the right to cancel, postpone or vary your programme of instruction. Should such a change become necessary and does not meet with your approval, Wallace College may at its discretion refund all or part of the course fees. Wallace College further reserves the right to vary the course venue within the city of Edinburgh.