CELTA

Course dates:

I would like to attend the following CELTA course

9th March 2012 - 5th April 2012

4th July 2012 - 31st July 2012

3rd August 2012 - 30th August 2012

2nd November 2012 - 29th November 2012

Personal details

Title:

Surname:

First name(s):

Date of birth:

Place of birth:

Nationality:

Mother tongue:

Telephone:

Country code:

Home number:

Mobile:

Country code:

Mobile number:

E-mail address:

Present occupation:

Present address:

Permanent address:

(if different from above)

In case of emergency:

Please give contact details of a person to contact in case of emergency: name, address, mobile phone and email address.

Medical information

Do you have / Have you had a medical condition we need to know about (including psychological conditions)?

Yes

Education and qualifications

Please state when and where you studied and give details (name of school/university/college and qualifications gained).

School:

Qualifications:

Dates:

School:

Qualifications:

Dates:

University:

Qualifications:

Dates:

ELT Qualifications:

Awarding body:

Dates:

Other relevant qualifications:

Knowledge of other languages:

Language:

Level of proficiency:

Language:

Level of proficiency:

Language:

Level of proficiency:

Other relevant experience

How did you find out about the CELTA courses at AVO-Bell School of English?
(website, Internet search engine, word of mouth - please give as many details as possible)

Are you applying to centres other than AVO-Bell School of English?

Any other information which you think is relevant to this application?

Referees

Please give the name, address, telephone number and email address of two referees who would be prepared to give relevant support to this application.

Personal statement

Please write why you want to do the course and how you feel you would most benefit from the course (150 - 300 words).

Accommodation

Would you like to take advantage of our Special offer with the accommodation included?

Yes

Please note

if you leave before the end of the course your fee is non-refundable
100% attendance is required
acceptance onto the course does not guarantee success: we screen applicants carefully, but inevitably some candidates fail

Terms of payment

Please do not pay anything until you have been interviewed, accepted and offered a place on a course.

Applicants who successfully complete the interview stage of the application process will be offered a place on one of our CELTA courses.
Once a place has been offered, it can only be confirmed when a non-refundable deposit of 200 EUR has been paid within one week of the interview. If you would like to take advantage of our Special offer the deposit is 300 EUR.
If the candidate is paying via bank transfer an amount of 20 EUR should be transferred to cover the candidate’s bank charges.
The deposit is not an additional fee and is deducted from the total costs.
The balance of the full CELTA course fee must be paid on arrival before the first class begins.

I will pay the non-refundable deposit (please tick the appropriate):

by bank transfer

by cheque

in cash

on-line (PayPal)

Cancellation of your application

Notice of cancellation must be made in writing.
If written notice of withdrawal is given 4 weeks or more prior to the start of the course, we will retain only the non-refundable deposit.
If written notice of withdrawal is given between 2 and 4 weeks prior to the start of the course, 50% of the fees will be returned to the applicant.
If written notice of withdrawal is given less than 2 weeks prior to the start of the course, no refund of fees is made.
All refunds will be made in the currency you have paid. Any bank or other charges payable will be deducted from the money refunded to you.

Declaration

I hereby declare that all the information I have given on this form is correct to the best of my knowledge and that any written work submitted is my own.

I have read and accepted the above conditions

Name:

Date: 22nd February 2012

A copy of this form will be e-mailed to you.

Phone:	+ 359 2 943 39 43
Phone:	+ 359 2 943 00 68
Mobile:	+ 359 896 888 458
E-mail:	t.training@avo-bell.com

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