Application Form for Residence
Ely University Centre - Summer Months

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

 Surname:  

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 First Name:  
 Home Address:  
 
 
 
 
 
 Date of birth:    Nationality:  
 Telephone No:    Religion:  
 Email Address:  
 
 School/University Attended:  
 Examinations passed:  
 Present Class/Year:  
 Years studying English:
 Level of English:  < Fluent / Quite good / Basic / Very basic >
 What are your hobbies?  
 What sports do you play?  
 How did you hear about Ely?  
 
 Arrival Date:    Depart Date:  
 Signature of applicant:    Date:  
 Signature of parent:    Date:  
 Booking Fee Cheque:    Bank Transfer:  

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