LEARN ENGLISH IN THE GARDEN OF ENGLAND APPLICATION FORM

PERSONAL INFORMATION Name: E-Mail: Address: Telephone: Fax: Nationality: Profession: Date of Birth: Smoker: Yes No Special diet/medical conditions: Any Allergies: Hobbies, leisure activities: Requested date of arrival: Requested date of departure: TEACHING INFORMATION Why do you want to learn English ?: For Business For pleasure To acquire a basic knowledge To improve written work To improve grammatical work To improve oral expression How long have you learnt English ?: What is your level of English ?: Elementary Lower Intermediate Intermediate Upper Intermediate Advanced Have you ever been to England before?: Yes No When: Reply Email Address :

[Home] Teacher: Penelope Mitchell (Diploma TEFL) ‘Fieldings’, The Street, Bearsted, Kent. ME14 4EX. U.K. Tel:+44(0)1622-737506 penelope@english-1to1.co.uk