I wish to study PLEASE TICK:

General English		IELTS Exam Preparation		Business English
Management		I.T		Technical English
One-to-One Intensive
Other Courses		Please specify subject:

From :				To :
Would you like to study? (PLEASE TICK OR FILL IN NUMBER OF HOURS REQUIRED FOR 1-1 LESSONS)
Full-time (21 hours/week) Part-time (15 hours/week) One-to-One Hours

Please tick the level of English at which you consider yourself to be at:

Beginner			Intermediate
Elementary			Upper-Intermediate
Pre-Intermediate			Advanced

Do you have any of the following English Language Qualifications?

Subject	Grade/score	Writing	Date of Examination	Place	Do You Have Certificate Yes/No
IELTS
TOEFL paper
TPEFL computer
Cambridge Preliminary
Cambridge First Certificate
GCSE / O Level
OTHER: (Please provide details)
Please provide proof that you have obtained the above qualifications (e.g photocopy of certificate)

Please find enclosed a copy of our course listings.

I will be paying for my studies

I will be sponsored Your sponsor must provide proof of sponsorship. Please attach this letter to your booking form if available.

Please provide details of your sponsor:

Why do you want to attend this course?

Which of these activities do you enjoy and in your opinion, helps you to learn? Please tick all that apply & add any others of your own:

1 Listening to the teacher and repeating

2 practicing in small groups or pairs

3 Using a text book

4. Watching videos

5 Listening to tapes

6 Using pictures

7 Tests & Homework exercises

Other :

How did you hear about CMLA?	Website   Former Students   British Council Walking-by   Tourist information   Prospectus Advertisement
	Other  , Please specify

CMLA can organise a taxi transfer from your arrival airport to Cardiff. If you would like us to do this, please complete the following information. (Please note that there is an additional charge for this service depending on the airport)

Arrival Airport?:	Flight Number:	Date of Arrival:
Arrival time:	Date of Departure?:	Departure time:

CMLA can help to organise a home stay with a host in or around the City of Cardiff. A deposit of £120 is required to register you of which, £110 is an initial host deposit and £10 administration fee. Please note: the deposit is non refundable if you do not arrive at your host as expected without prior notification to CMLA. No more than three students will be accommodated in a home stay host at any one time. Also, please read terms and conditions at the end of the booking form and full terms and conditions available on our website www.cmla.uk.com. If you would like us to locate you a host, please complete the following.

Accommodation dates:

From:             To:

1.Do you smoke?	Yes       No
2.Diet requirement?	Yes       No	if so what?
3.Do you have any allergies?	Yes       No	if so what?
4.Do you accept pets (dogs & cats)	Yes       No

(Meals in home stay will be provided as agreed and will offer a well-balanced diet, taking into account any reasonable dietary requirements expressed by students).

To assist us in finding a host that is suitable please write a short story about you.

	Yes	No
1.Are you suffering from any illness?			if yes, what is it?
2.Are you registered disabled?
3.If yes, do you need any special arrangements?			if yes, what are they?

In case of problems, who would you like CMLA to contact on your behalf?

Name and Address of Next of Kin:
    

Contact telephone number:
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