Concord College - Application Form

The full fees are due four weeks before the course begins and include tuition, full board and residence, London Heathrow Airport transfers on the first day and last day of each course, excursions, use of textbooks, stationery and some laundry. GBP250 of the above course fee is payable upon booking a student in order to secure a place.

The College can accept no responsibility for deductions made from any payment in respect of bank charges.

Family name:

First names:

Gender:

Male Female

Date of Birth

Nationality:

Mother Tongue:

Name of Parent or Guardian:

Address:

Telephone:

Fax:

Email of Parent / Guardian:

Address during course (if different from above):

My bank is :

For how many years has the applicant studied English?

years

Does applicant suffer from any illness requiring special care?

Yes No

If yes, please give further information:

Do you require an invitation letter for a Visa application?

Yes No

“Skills Extra ” Golf / Tennis / Horseriding?

Yes No

THE COURSES
Please indicate which course you wish to attend

		Please tick:
ENGLISH COURSE A at Acton Burnell Hall for ages 8-18 Sunday 2 July to Thursday 27 July 2006

SCIENCE COURSE B at Acton Burnell Hall for ages 13-17 Sunday 2 July to Thursday 27 July 2006
PLEASE INDICATE SCIENCE SUBJECTS OPTION B1-B4 IN BOX OPPOSITE B1 Maths/Physics B2 Chemistry/Physics B3 Chemistry/Biology B4 Maths/Biology

ENGLISH COURSE C at Acton Burnell Hall for ages 8-18 Sunday 30 July to Sunday 20 August 2006

SCIENCE COURSE D at Acton Burnell Hall for ages 13-17 Sunday 30 July to Sunday 20 August 2006
PLEASE INDICATE SCIENCE SUBJECTS OPTION D1-D4 IN BOX OPPOSITE D1 Maths/Physics D2 Chemistry/Physics D3 Chemistry /Biology D4 Maths/Biology

FEES:
I ENCLOSE THE BOOKING FEE WITH THIS APPLICATION. PLEASE TICK YES OR NO.

Yes No

I HAVE INSTRUCTED MY HOME BANK TO TRANSFER THE BOOKING FEE (TO INCLUDE BANK CHARGES) TO:-
BELL CONCORD EDUCATIONAL TRUST LTD.
ACCOUNT NUMBER 00157422
SORT CODE 20-77-85
BARCLAYS BANK PLC 44
CASTLE STREET, SHREWSBURY,
SHROPSHIRE SY1 2BU, UNITED KINGDOM

IBAN GB43 BARC 2077 8500 1574 22 BARCGB22

PLEASE TICK YES OR NO.

Yes No

PLEASE SHOW THE DAY & MONTH ON WHICH YOUR MONEY WAS REMITTED:

Day: Month:

PLEASE NOTE: NO REGISTRATION CAN BE COMPLETED UNTIL THE BOOKING FEE HAS BEEN RECEIVED. UPON RECEIPT OF COMPLETED APPLICATION FORM AND BOOKING FEE, A CERTIFICATE OF ACCEPTANCE WILL BE ISSUED.

PAYMENT SHOULD BE IN POUNDS STERLING BY BANK TRANSFER OR BY CHEQUE DRAWN ON A UK CLEARING BANK.

I UNDERSTAND THAT THE OUTSTANDING FEE MUST BE REMITTED TO CONCORD COLLEGE FOUR WEEKS BEFORE THE START OF MY CHILD’S COURSE.

PLEASE INCLUDE THE STUDENT’S NAME ON ANY BANK TRANSFERS.