College of St Mark _ St John by mudoc123



   Centre for International Language Teacher Education


   Please read the Terms and Conditions on pages 3 & 4 before completing this form.

   International Office                                                    ATTACH YOUR
   University College Plymouth St Mark & St John                           PHOTO HERE
   Derriford Road, PLYMOUTH PL6 8BH, UK

   Telephone +44 (0)1752 636821
   Fax +44 (0)1752 636802

PERSONAL DETAILS                                           YOUR COURSE DETAILS

                                                           Title and Dates: please tick []
Family Name or Surname
                                                              Teaching English to Young & Very Young Learners
First or Given Names                                          (4–15 July 2011)
                                                              Language Development & Methodology for Teachers
Current Postal Address                                        (4 –15 July 2011) [code: UK-2011-1331-002]
                                                              Language Development & Methodology for Teachers
                                                              (18-29 July 2011) [code: UK-2011-1331-002]

                                                           Where did you first find out about our courses?




Occupation                                                 ABOUT YOU & YOUR STUDENTS
Date of Birth      dd/mm/yy
                                                           How many years have
Religion                                                   you been teaching?
                                                           How would you describe
Name, address and telephone number of first                your level of English?
person we should contact in the case of illness            Pre-intermediate/
or accident                                                Intermediate/Advanced

                                                           What age group/s do you
                                                           usually teach?

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We shall do our best to provide the type of           FOR HOMESTAY ACCOMMODATION
accommodation you give as your first choice, though   ONLY – PLEASE DO NOT COMPLETE
this may not always be possible.                      IF YOUR REQUEST IS FOR CAMPUS
Please tick your preference ()
                                                      Do you smoke?                         Select from list
                                                      If you are a non-smoker, would
Homestay                                              you live in a house where other       Select from list
                                                      people smoke?
                                                      Would you live in a house
                                                      where there are pets (e.g.            Select from list
Do you have a           Select from list              dog/cat)?
special diet? (if so,
please specify)

Do you have             Select from list              Please list any hobbies or interests you have
allergies? (if so,
please specify)

Do you have any
medical conditions
or disabilities we
                        Select from list
should know about?

If Yes, please                                        INSURANCE
complete the
attached Sensitive
Personal Information                                  Would you like us to arrange
form on page 5                                        insurance for you?

                                                      If not, you are expected to arrange
                                                                                                Select from list
                                                      your own insurance (see Insurance
                                                      in the Terms and Conditions on
                                                      page 3)

   Please add below any further information that you feel would be helpful to us in providing
   an appropriate course

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Arrival and Departure
You should aim to arrive at the College on the Sunday afternoon before your course begins and collect
your Welcome Folder at Reception. Courses normally begin on Monday at 9.30am. Departure is
normally on the Saturday morning after your course ends. It may be possible to book extra nights at an
additional cost.

You must have full health insurance while taking your course. You will be required to show proof of your
insurance prior to your arrival in the UK.

Some countries have a reciprocal health agreement with the UK. If your country has one you should
obtain all necessary forms and documentation before leaving home. Full details of reciprocal
agreements are at

In addition, we always recommend that you take out full private insurance for travel, cancellation, loss of
property etc.

  Booking your place on a course
   To make sure of your place you must send us a non-refundable deposit of £100 or proof of
    payment with your application
   As soon as we have received your deposit, we will send you an acceptance letter, together with an
    invoice for the balance of the course fee and accommodation
   If the course is full, we will refund your deposit

Acceptance Letter
 You need an acceptance letter if you require an entry visa to the UK
 You can find out if you need a visa by visiting
 If you do not need a visa, you should carry your acceptance letter with your passport as immigration
  officials will want to see evidence that you intend to study in the UK

 Requests to cancel must be made in writing by letter, fax or e-mail
 If you cancel less than four weeks before a course starts, you are liable for the full cost of tuition and
  accommodation fees (you are advised to insure against cancellation)

Changes to courses
 We reserve the right to cancel a course if there are not enough participants enrolled on it. If this
  happens to you we will offer you the choice between a place on another course or a full refund of fees
  and deposit
 We reserve the right to adjust fees and the cost of board and accommodation and to cancel or alter

 We will normally send you details of the accommodation we have booked for you before you arrive. If
  this accommodation then becomes unavailable, we will tell you immediately and arrange similar
  alternative accommodation

 Fees are for complete courses
 No refunds can be made if you arrive late, leave early or are absent from class during the enrolled
 If you leave homestay accommodation before the end of the period you booked it will not be possible
  to make a refund available

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Payment for Courses and Accommodation
Please read the notes carefully on Page 3 above. If you would like further clarification or assistance, please contact
the International Office by email ( tel (+44 (0)1752 636821) or
fax (+44(0)1752 636802).

1. Deposit
In order to confirm your enrolment on the course, please return this completed form, along with a non-refundable deposit of
£100. The deposit will be deducted from the course fee

2. Course Payment
Full payment for the course and any accommodation booked must be paid (less the deposit) at least 3 weeks before the start of
the course.

3. Methods of Payment
 i) By a Sterling Cheque, drawn on a UK bank, forwarded by post. Please tick the box if you are using this method

ii) By Bank Transfer or Banker’s Draft in £s forwarded to:

a) Payment in Sterling
Bank Details:
                 College of St Mark and St John
                 General Fund Account No: 80499919
                 Sort Code: 20 68 10
                 Barclays Bank, 50 Cornwall Street
                 Plymouth PL1 1LU
                 United Kingdom
                 SWIFT code: BARCGB22
                 IBAN number: GB70 BARC 2068 1080 499919

iii) By Credit Card
by Visa/Mastercard/Deltacard/Switch Maestro (in £s sterling only)
The following details are required. Please complete below if using this payment method.

   Card type:
   Card Number:
   Date valid from (if applicable):
   Date valid to:
   3 digit Security Code (on back of card):
   Name of Cardholder (as it appears on the card):
   Signature/Name of Cardholder:

Important Notes
If you are paying by Credit Card, please DO NOT return this form by email with your credit card details. You should
return it by fax, secure post or telephone direct to the Accounts office on +44(0)1752 636805. You can also send the
form by email, but without these details.

Confirmation of Payment Method
Please confirm which method of payment you are using:

                            Deposit                   Remaining fees and Accommodation Costs
Sterling Cheque
Bank Transfer/Draft
Credit/Debit Card

Please forward forms and enquiries to: Michelle Charlick, International Office, University College Plymouth St Mark and
St John, Derriford Road, Plymouth PL6 8BH, UK. (Tel: +44(0)1752 636821; Fax: +44(0)1752 636802; email:

Signature/Name:                                                             Date:

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Sensitive Personal Information Sheet
    Date of Birth
    Course Dates

    Do you have any medical conditions or disabilities we should know about?
        Yes                 No
    If Yes, please complete the sensitive personal information below:
    I consider myself to be disabled or have special needs according to the following
    descriptions: please tick () the appropriate boxes
        (1) Dyslexia or other Specific Learning Difficulties
        (2) Blind/Partially sighted
        (3) Deaf/hard of hearing
        (4) Wheelchair User/Mobility difficulty
        (5) Autistic Spectrum Disorder/Aspergers
        (6) Mental Health Difficulties
        (7) Unseen disability
        (8) Two or more of the above
        (9) A disability or special need not listed above

    Please give us any more information that you think may be important for us to know.

    Sharing Information
        require details disclosed to be entirely confidential
    I understand that should I limit the dissemination of essential information, I may affect the
    College’s ability to ensure that all reasonable adjustments are made and that the College will
    not be liable if any of its departments or employees could not reasonably have known of my

    I agree that essential details of my disability, particularly any necessary adjustments, may be
    shared with the following:

        The Course Leader                               Other College Staff, eg library, catering,
        The Teaching Team                               cleaning
        Personal Tutor/Local Tutor (in-country)         The International Student Welfare Team
        The Accommodation Officer                       Homestay Providers
        The Disability Advice & Support Team

    Your Signature/Name:                                        Date:

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