University Language Centre - DOC - DOC

							                                        University Language Centre
                                        Gateway Programme


                                        APPLICATION FORM 2011 – 2012
For Administration Purposes Only                            Agent/Spon:                                       Ref:
Course         Dates       Wks Deposit             Date         Ref           Balance          Date                  Ref
         Start    Finish




SECTION A

A1. Personal Details

Family Name:                                              Title: Mr    Mrs     Ms       Miss    Prof     Dr

Other Name(s):                                            Gender: Male       Female

Passport Number:                                          Date of Birth (dd/mm/yy):                    Age:

Nationality:                                              First Language:

Country of Birth:

Occupation:                                               Subject/Area of Work:

Home Address:


Post Code:                                                Country:

Telephone:                                                Fax:

E-mail:

Address for CORRESPONDENCE (if different from home address):
**If applying via an agent, please confirm Agent details here

Post Code:                                                Country:

Telephone:                                                Fax:

E-mail:


A2. Level of English (Please note ULC only accepts beginners or very low level students on special or 1:1 courses)
What is your present level of English? MUST be at least A2 on the Common European Framework for Languages
(e.g. 3.0 overall in IELTS)
Reading: select level          Writing: select level        Listening: select level  Speaking: select level

Are you attending an English language course now? If so, please say where and at what level:

Name of most recent English language examination passed (if any) the date passed and result:


If IELTS: Listening:        Reading:         Writing:        Speaking:         Overall:         Date Taken
SECTION B: Gateway Programme (English for Personal, Professional & Academic Development)
Please indicate the date your start date and write in your finish date and the number of weeks you wish to study for.
Minimum period of study: 4 weeks, deposit: £960, fee per week: £240
I wish to study for the following reasons: Personal             Professional       Academic/University Preparation
      Course                   GW T1/11                GW T2/12                    GW T3/12                  GW T4/12
                            19 Sept - 16 Dec     9 Jan 2012– 30 March        16 April – 15 June          25 June 2012 – 07
                            2011 (13 weeks)         2012 (12 weeks)             2012 (09 weeks)        Sept 2012 (11 weeks)
      Possible           19 Sept                9 Jan                          16 April                25 June
     Start Dates
                         17 Oct                 13 Feb                         14 May                  23 July
                         21 Nov                 05 March
     Finish Date
Number of weeks


SECTION C: Fees
C1: Fees
My course fees will be paid by: Myself/family                Government agency/sponsoring organisation

Name and address of sponsoring organisation                          File/Ref No. (sponsored students only)

I enclose

Copy of bank transfer                      Sterling cheque                            Debit/Credit card form

Certified Letter of Sponsorship for an English course

For the following amount:
1.
       Deposit of: £960                                                                                   TOTAL: £960

2.     Course fee in full                                                                                 TOTAL: £

C2: Accommodation
Accommodation forms are available at http://www.ulc.manchester.ac.uk/english/full-time/accommodation/


Please note:
1) The University Language Centre does not organise residential and/or private accommodation October-June.
2) Students must be accepted onto a course (and if relevant, paid the deposit/submitted a letter of sponsorship) before they
can apply for University Halls of Residence and before their Homestay Accommodation application will be processed.

SECTION G
D1: Study Plans after your course

Do you intend to apply to a British University?                                            Yes                 No

If yes, at what level:           Foundation Year                               Undergraduate           Postgraduate

Have you already applied to a British University?                                           Yes                  No

To which University in Britain have you made an application?

Department/School Name:                                                                       Degree Title:

Course Title:                                                                Start Date: (dd/mm/yy)

Have you been offered a place? Yes             No             If yes, is your offer unconditional      or conditional

Details of any English language conditions relating to your offer:
D2: Disability / Special Needs

Do you have a Disability / Special Needs?                              Yes                                                        No

If yes, please give details and supply the relevant documentation:


The information you provide will be used in the processing of your application to assess whether we have the facilities to support your need, or to
assess whether your situation may put yourself or others in danger. Such details will only be disclosed to those having legitimate need to see them.


D3: How did you hear about the University Language Centre?

A previous student of this University                        A department of Manchester University
An Educational Consultant /Agent                             Name of agent
The Internet                                                 State which website
A Study Abroad Guide                                         Name of guide
Magazine/newspaper                                           Name of magazine/newspaper
Other                                                        Please give details:


SECTION H: Declaration

I enclose with this application: (please indicate)
    A copy of my passport and current visa (if applicable)
    Copies of English language test results (IELTS/TOEFL/Cambridge)/Evidence of my level
    A non-refundable deposit of £960 (self-financing students only)
    A certified Letter of Sponsorship (sponsored students only)
    A copy of offer letter from university department (if applicable)
    A colour passport sized photograph

I understand that:

    I will only receive an acceptance/visa letter/CAS if I have paid the course deposit(s) and supplied the required
     documents

    I must pay the balance of my course fees for the full period booked within 20 working days before the start of
     the course, and that my place is not guaranteed until the balance is paid in full.

    I must provide a sponsorship letter for the English language course (sponsored students only)

    Homestay accommodation will only be arranged after I have paid the homestay deposit (or if applicable ULC
     has received a letter of sponsorship for an English language course) and accepted my unconditional offer

    Applications for summer hall accommodation will only be processed after I have paid the hall fee in full

    I am responsible for arranging my own insurance (travel, health, loss of/damage to property)

    I will only receive a Certificate of Attendance if I achieve an attendance record of at least 80%


I HAVE READ AND UNDERSTAND THE BOOKING CONDITIONS

Signature of applicant:                                                                               Date: (dd/mm/yy)

Name of person signing on behalf of applicant:

Signature:                                                                                             Contact Tel/Email: