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TKT: CLIL Module

Course information:

I would like to attend the following course:

Course name: TKT: CLIL Module

Start date: 7th April 2012

7th April 2012 - 28th April 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.

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:

Work experience (write in chronological order with most recent first)

Employer: Position: From (month/year): To (month/year):

Other relevant experience

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

Any other information which you think is relevant 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).

Please note

if you leave before the end of the course your fee is non-refundable
100% attendance is required

Terms of payment

To reserve your place on a course you will have to pay the tuition fee in advance.
Tuition fee does not include exam entrance fees.
Tuition fee does not include bank charges for payments made by bank transfer.

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

by bank transfer

by cheque

in cash

Cancellation of your application

Notice of cancellation must be made in writing.
Failure to provide written notification will result in charges being incurred.
If written notice of withdrawal is given 4 weeks or more prior to the start of the course, we will refund the full tuition fee minus 10 % administration fee.
If written notice of withdrawal is given between 2 and 4 weeks prior to the start of the course, 50% of the tuition fee will be refunded.
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.

Recent photo

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