Photograph Please send us a jpg photograph of yourself by email.

International English Centre

Application Form 2013-2014

International Pathways Courses (Foundation & Pre-Masters)

Section One: Personal Details
Title	Other
Family name
Given name(s)
Date of birth
Gender (Male/Female)
Nationality
Place (city) of birth
Country of birth
First Language
Passport number
Your home address
Your telephone number
Your email address
Contact address (if different)
Contact telephone number (if different)
Contact email address (if different)
Do you have any disability?
If ‘yes’, what adjustments do you need us to make?

Section Two: Choose your course(s)
Pre-Foundation English Course	23 September 2013 – 13 December 2013	12 weeks	£2,400
International Foundation Programme	23 September 2013 – 30 May 2014	30 weeks	£8,250
International Foundation Programme	06 January 2014 – 05 September 2014	30 weeks	£8,250
Fast Track International Foundation Programme	27 January 2014 – 30 May 2014	15 weeks	£5,000
Pre Masters Programme	23 September 2013 – 30 May 2014	30 weeks	£8,250
Pre Masters Programme	06 January 2014 – 05 September 2014	30 weeks	£8,250
Fast Track Pre Masters Programme	27 January 2014 – 30 May 2014	15 weeks	£5,000

Section Three: Choose your subject	Other

Section Four: Previous Experience of English
How many years have you studied English?
Have you taken a test in English (e.g. TOEFL, IELTS, Pearson)?	Other
What was the date of the test?
What was your score?	Listening
Reading
Writing
Speaking
Overall Score

Section Five: Accommodation
Do you want university accommodation?

Section Six: How you heard about us
How did you first hear about our courses?	Other

Section Seven Postage
Please send my offer letter by

Information: How to Pay
• BANKERS DRAFT / CHEQUE in sterling (GB pounds) made payable to “Aberystwyth University” and sent to the International English Centre, Llandinam Building, Penglais Campus, Aberystwyth, SY23 3DB, Wales, UK. • BANK TRANSFER – Please email the bank receipt to us. You can send both the deposit and the balance of fees in a single transfer. Bank charges and commission for both the sending and receiving banks should be paid by the sender. Only the amount received in our bank will be credited to your invoice. The details you require are as follows: Name of Bank: HSBC plc, 19 Great Darkgate Street, Aberystwyth SY23 1DH, UK Bank sort code: 40.08.09 Account No: 01197339 Name of Account: ABERYSTWYTH UNIVERSITY GENERAL ACCOUNT (G1053-02 1950) IBAN code: GB41MIDL400809 01197339 SWIFT code: MIDLGB22 • CREDIT/DEBIT CARD Please phone or email our office to pay by card.

Section Eight: Payment
Please send me an invoice before you issue my Confirmation of Acceptance for Studies
I am now paying	Non-refundable deposit of £1,000 OR Full Tuition Fee	Amount
Accommodation	Amount
Special delivery charge of £25	Amount
Total	Amount

Section Nine: Documents - Please confirm that you are sending the following documents:
Certificates and transcript from your school or university
English Language certificate, e.g. IELTS or TOEFL
Reference from your teacher or professor
A Personal Statement from you
A Portfolio of your work (Art applicants only)

Section Ten: Declaration
By entering my name below, I certify that
I am in good health and I am not suffering from any disease likely to interfere with my studies or with the health of other students. I understand that I must attend all classes regularly and participate in the lesson activities. I agree to pay my course fees and accommodation costs in advance or at registration on the first day of the course. I understand that I may not join the course unless my fees are paid. I have read and understood the Information for Students. All the above information is correct and complete.
Enter your name in the box

© International English Centre, Aberystwyth University, 2012