Ely University Centre - Summer Months

Application Form for Residence

(This application form can be copied and sent to us by email or by fax).

Surname _______________________________________

Christian name __________________________________

Address _______________________________________ ATTACH PHOTOGRAPH HERE

_______________________________________

_______________________________________

Date of birth ____________________________________

Nationality ______________________________________

Religion _______________________________________

Tel No _______________________________________

Email _______________________________________

Schools / University attended  ____________________________________________

Examinations passed ____________________________________________________

Present Class/ Year _____________________________________________________

How long have you been studying English? ________________________________

At what level is your English? Fluent ____ Quite good ____ Basic ____ Very basic _____

What are your hobbies? ______________________________________________________

What sports do you play? _____________________________________________________

How did you hear about Ely? ______________________________________

I wish to apply to stay from _________________ to ___________________

Signature of applicant _________________________ Date __________________

Signature of parent/ guardian ______________________ Date __________________

Booking Fee Cheque _________________ Bank Transfer ____________________