Personal Details

Title: *

Mr Miss Mrs Ms
Other (please state):

Family Name: *

First Name(s): *

Address: *

Country: *

Nationality: *

Date of Birth (DD/MM/YYYY): *

Age: *

Tel: *

Country Code: Area Code: Tel No:

Fax (incl. country & area code):

E-mail: *

Passport Number: *

Course Details

Start Date (DD/MM/YYYY): *

Finish Date (DD/MM/YYYY): *

Total Weeks: *

What Is Your Current Level Of English?: *

Elementary Pre-Intermediate Interemediate
Upper-Intermediate Advanced

Please choose which course you would like to study. *

Standard Courses:

General English

Lessons per week: 20

Intensive English

Lessons per week: 30

Business English

Lessons per week: 30

Summer Course

Lessons per week: 20

Summer Intensive

Lessons per week: 30

Examination Courses:

Examination Preparation

Lessons: 20 30

Wessex Academy Year Courses:

Wessex Academy Year (WAY)

Course length: 6 months 9 months

General English Long Courses:

General English Long Courses

Course length: 24 weeks 36 weeks 44 weeks

Specialist Courses:

English & Computing

2 Weeks 4 Weeks

English & Tennis

2 Weeks 4 Weeks

English & Golf

2 Weeks

Arrival Details (if known)

Arrival Date (Sat/Sun) (DD/MM/YYYY):

Arrival Time:

Flight Number:

Airport:

Heathrow Gatwick Southampton
Other (please state):

Departure Date (Sat/Sun) (DD/MM/YYYY):

Do You Want A Taxi Transfer?:

On Arrival Day: On Departure Day:

Accommodation Details

Please indicate the type of room you
require: *

Single Room: Twin Room:

Smoking or Non-smoking?

Smoking: Non-smoking:

Please state any special
accommodation requests:

Dietary:

Special:

Medical:

Declaration

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Please click this box to confirm you have read and understood the terms and conditions.

Email Address: