STUDENT APPLICATION FORM FOR ENGLISH IN ACTION
Completed forms should be returned to: Jennifer Luk English-Speaking Union, Dartmouth House 37 Charles Street, London W1J 5ED jenl@esu.org Personal Details Title: (Mr/Miss/Mrs/Ms) First Name:
Family Name:
Other names: Date of birth:
Gender:
Address: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Home/ Mobile phone: _______________________ Work phone: ______________________ Email: Nationality:_______________________________________________________________ Academic/Employment details Current Occupation:
What is your level of English (Basic, intermediate, advanced?) ________________________________________________________________________ How long have you studied English? What exams have you taken?
Why do you want to take part in English in Action? What do you want to learn?
What are your interests?
Do you have any special requirements for a tutor?
Where did you hear about this programme?
Availability (please tick) Morning Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Afternoon
Evening