Application Form Personal Details First Name: Last Name: Date of Birth: Gender:MaleFemale Nationality: Passport/ID number: Address in your country: Address in London: Phone number: UK Phone number: E-mail: Emergency Contact Details Full Name: Relationship to you: Do they speak English?:YesNo Mother tongue (language spoken at home): Email address: Phone number: Course Details Course name: Course starting date: Number of weeks: English level:---BegineerElementaryPre-IntermediateIntermediateUpper-IntermediateAdvancedProficent Accommodation Not requiredHomestayResidence Arrival date: Departure date: Weeks: Zone:1234 Room type:SingleTwinDouble Homestay Meal plan:Bed&BreakfastHalf-Board Preferences:No CatsNo DogsVegetarianVeganGluten free Allergies / Special requests: Residence Preferred facilities: Studio (private bathroom and kitchen)En-suite (private bathroom)Single room (room only) First choice residence: Second choice residence: Transfer Not requiredOne-wayReturn Arrival Date of arrival: Time of arrival: Airport:---HeathrowGatwickLutonStanstedOther Flight Number: Departure Date of departure: Time of departure: Airport:---HeathrowGatwickLutonStanstedOther Flight Number: Visa Do you need to apply for visa?YesNo If yes, what type of visa are you applying for?---General student (Tier4)Short-term Study Visa (6 months)Short-term Study Visa (11 months)Child Visitor visaOn arrival (non-visa nationals onlyTourist visaOther Have you previously been refused a visa or entry into the UK?YesNo If yes, please give details: Reasons for studying English Why did you decide to enrol on an English course?WorkStudiesTravelOther Why have you chosen to study in the UK? Why have you chosen to study at Rose of York Language School? What do you plan to do when you finish your course? Previous study history Please provide details of your previous studies in English:High SchoolUniversity / CollegeLanguage School in your countryLanguage School in UK / other country Have you taken an official English Examination?YesNo If yes, please give details: Additional information How did you hear about Rose of York?---GoogleBritish Council / English UKPassing byFriend / RelativeFormer studentEducational Agent Payment Courses and accommodation can only be confirmed once full payment has been received. Please choose your preferred method of payment:Bank transferCredit/Debit CardOnlineCash We advise that you take out insurance for your own security. You can take out your own insurance or the ones offered by either Endsleigh International Student Insurance or the International Student Policy offered by Guard.me. Students from the EU should bring their European Health Insurance Card.Students under 18 must take out insurance and send proof to the school before departure. I have read and accept the Terms and ConditionsI confirm that the details provided above are correct and complete.