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					     Application form for admission to the Pre-sessional English Language
                          Programmes (PELP) 2012/13

                    12-week PELP: 25 June 2012 - 14 September 2012
                     8-week PELP: 23 July 2012 - 14 September 2012
                     4-week PELP: 20 August 2012 - 14 September 2012

  Please complete the form in block capitals and indicate which programme you are
                 applying for, i.e. 12-week, 8-week or 4-week PELP.

 Pre-sessional English Language Programme applied for (please tick ())
                                         12 weeks            8 weeks                4 weeks

 Family Name:

 Given/First Name:

 Male/Female:                             Student Reference No:

 Date of Birth:


 Home Address:

 Tel No:                                 Email:

 Address for correspondence if different from home address (e.g. agent name & contact details):

 Tel No:                                 Email:

 Address valid until (date):

Do you need specific support for any disability or medical condition? Please tick () below as
appropriate. Please note if you tick the ‘Yes’ box you are stating that you need specific

              Yes                                                 No
If you answered ‘yes’, please give us further details below.



Please indicate the course you intend to follow at Royal Holloway. Please tick ( ).
        Undergraduate                Postgraduate
        Graduate Diploma                      Other

 Title of course:

 Please give details of the score and date of any English language examinations taken (e.g.
 IELTS or TOEFL). If you have taken IELTS, please give the Test Report Form number, which is
 on the bottom right of the certificate:

 How did you find out about this programme?

I confirm that I have completed this form myself:

Signature:                                                       Date:

Please see the flyer for the Pre-sessional English Language Programmes for further
information on English language entry requirements.

Please enclose a copy of the personal details page in your passport

In order to reserve a place on one of the Pre-sessional English Language Programmes,
provided you have received an offer letter for the Pre-sessional and met the conditions, please
send the following:
     £3,210, the tuition fee in full, for the 12-week PELP by 09 May 2012; or
     £2,145, the tuition fee in full, for the 8-week PELP by 04 June 2012; or
     £1,090, the tuition fee in full, for the 4-week PELP by 02 July 2012 to:

                                        Royal Holloway International
                                    Royal Holloway, University of London,
                                        Egham, Surrey, TW20 0EX
                                               United Kingdom

                                        Tel: +44 (0) 1784 414037
                                        Fax: +44 (0) 1784 477640

Please pay by using one of the following methods:

1. By credit or debit card, using ePay, Royal Holloway’s secure online card payment service. This
   is the simplest method. The web address is:
2. By cheque.       Please make cheque payable to ‘RHUL’ and send it to Royal Holloway
   International. The cheque should be in sterling and can be drawn on a London bank.
3. By bank transfer. Please send transfer to: NatWest Bank
                                              50 High Street
                                              Egham, Surrey
                                              TW20 9EU
                                              United Kingdom

                                                    Bank Sort Code:      60- 07-33
                                                    Account Number:      02325330
                                                    IBAN:          GB82 NWBK 6007 3302 3253 30

Please include your name, address, student reference number and quote ‘Pre-sessional
English Language Programme’ with all payments.

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