University Language Centre by h1t57iw

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									                                                          University Language Centre
                                                          ENGLISH LANGUAGE COURSES

                                                          Part-Time Cambridge ESOL Examinations
                                                          (FCE, CAE, CPE) Preparation Courses

                                                          Application Form 2012/12
For Administration Purposes Only
Course Applied:                                 Date:                                    Course Payment:                           Exam Payment:




SECTION A
A1. Personal Details (please write in BLOCK CAPITALS)

Family Name: ...........................……...............           Other name(s): .............…................................... Title: ....................

Male                               Female                           Date of Birth (Day/Month/Year): ......................... Age: .....................

Nationality: .........................................   First Language: ..........................      Occupation: ..........……….…..............

Address for correspondence:............…………………….................................................................................................

 .............….......................................... Post Code: ..........….........…........       Country: .........…...….…....…...…............

Tel.: ............….........…………............             Fax: ..........….......…......…...........      E-mail: ............……...….....…..................


 A2. 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.

A3. Level of English

Title of most recent English language examination passed (if any): ..............................................................................
Date passed (dd/mm/yy): ..................................... Result:............................................................. ...............................

**Please enclose a copy of your certificate**


SECTION B
 Please  the exam course you wish to follow.
 Your English will be tested to ensure you follow the correct course for your level.

                                  First Certificate FCE                   Advanced Certificate CAE                   Certificate of Proficiency CPE
SEPTEMBER
START
JANUARY
START

                             Cambridge Examinations take place in December 2012 and June 2013.
                                        Exam fees are not included in the course fee.
SECTION C
C1. Fees

Name of person/organisation who will pay the course fee: ..............……………............................................................

If sponsored, address of person/organisation (for invoice): ………………………………………………………………....

........................................................................................................................………..................…................................

C2. Finding out about studying English at Manchester University

Please indicate where you found out about the part-time Cambridge examination courses provided by the University
Language Centre, The University of Manchester: ...........……………………………………………………………….……

C3. I am : (please indicate with a tick )

A student at Manchester University                                 Course/Department: ……..….……………………………..…………......…
A student elsewhere                                                Please give details: ….……………………………………...………………
An employee of Manchester University                               Job Title/School: ………..………………………………………..…………..
An employee elsewhere                                              Please give details: ……..………..………………………………….………
Other                                                              Please give details …………………………………………………………..

SECTION D: Declaration

I enclose with this application: (please tick )

     Copy of written proof of sponsorship (sponsored students only)

     Course Fee                     1 (25.09.12 - 29.11.12):                                                     £385.00

                                     2 (29.01.13 - 21.03.13 & 09.04.13 - 23.05.13): £575.00
                 I will pay online following the instructions given by Admissions
                 I enclose cheque payable to ‘The University of Manchester’

I understand that:
           I must take an assessment test to ensure I follow the correct course for my level
           I must pay the course fee before I can join a class
           Exam fees are not included in the course fee
           Exams will only be held at ULC if there are the minimum number of exam candidates as required
            by the Examination Board
           Fees, less a booking fee of £80.00 can only be returned if I cancel my booking in writing at least 7
            working days before the start of the course
           My fees cannot be refunded if I start the course late, leave early or miss any lessons
           Because this is a part-time course, I am not eligible for a student visa
           The ULC reserves the right to cancel or change the course programme

Signature of applicant: ......…....................................................................                            Date .................................

PLEASE SEND COMPLETED APPLICATION FORM TO:

                                     English Language Courses, Oddfellows Hall, University Language Centre
                                        The University of Manchester, Oxford Road, Manchester M13 9PL

                          Tel: 0161 306 3397                   Fax: 0161 306 3396                   Email: englang@manchester.ac.uk

								
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