EC ENROLMENT FORM 2020

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STUDENT INFORMATION
First Name: Family Name:

Gender: Male Female Date of Birth: DD | MM | YYYY Country of Birth:

Nationality: Mother Tongue:

Address:

Country: City: Postcode:

Tel: Student Email: Passport No:

EMERGENCY CONTACT | LEGAL GUARDIAN – If the student is under 18 years of age

First Name: Family Name:

Tel: Email:

AGENCY

Are you applying through an agent? Yes No If you answered Yes Agency Name:

Agent email: Contact person:

WHERE DO YOU WANT TO STUDY?

USA Canada UK & Ireland Malta & S. Africa ANZ Australia &
New Zealand

Boston San Diego Montreal London Bristol Malta Melbourne

New York Los Angeles Toronto London 30+ Manchester Malta 30+ Sydney
New York 30+ Miami Toronto 30+ Oxford Dublin Cape Town Brisbane
Washington Vancouver Cambridge Dublin 30+ Gold Coast
San Francisco Vancouver 30+ Brighton Auckland

YOUR LEVEL OF ENGLISH?

If you have completed an exam such as IELTS or TOEFL
Beginner Pre-intermediate Upper-intermediate Advanced
please provide a copy of your certificate.
Elementary Intermedediate Pre-advanced Proficiency

COURSE INFORMATION
Course Name: How many lessons per week:

Start Date: DD | MM | YYYY Courses run from Monday to Friday Number of weeks:

ENGLISH PLUS UNIVERSITY ADMISSION SERVICE

Are you going to apply for a EC partner university or college? Yes No

Name of Extra Activity:

Diving Options: PADI Open Water PADI Advanced PADI Combined What Country? Canada USA Australia Malta

EXTRA SUPPORT
Do you have any learning or physical needs that require support?
(e.g. sight impairment, dyslexia).
What support do you require?

VISA
What type do you plan to hold while you are studying at EC?

Student Working holiday Visitor Other Please specify:

AUSTRALIA & NEW ZEALAND ONLY

If you answered Student - where will you be when you apply for your visa?

Country: City:
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TRANSFERS & FLIGHT INFORMATION

Transfers One Way Arrival Date: DD | MM | YYYY Departure - Airport / City:
required
Return Arrival Flight No:
Arrival - Airport:
Arrival Time: including terminal
None

ACCOMMODATION - Saturday to Saturday* Number of Weeks

Do you require accommodation? Yes No Arrival Date: DD | MM | YYYY Departure Date: DD | MM | YYYY
* Malta: arrival and departure can be either on Saturday or Sunday. Australia & New Zealand: no fixed arrival or departure days.

Name of your accommodation?

DON’T KNOW? CHOOSE HERE – what type of accommodation would you like? HOMESTAY or RESIDENCE / APARTMENTS

HOMESTAY RESIDENCE / APARTMENTS

Room Type Single Twin Room Type

Bathroom Type Shared Private Bathroom Type

Board Status Half Board B&B Self Catering

EARLY ARRIVALS AND EXTENSIONS

When a student requests a stay of For stays of 1 or 2 nights For stays of 3+ nights
less than 7 days, or additional nights Availability can only be guaranteed within 21 days of arrival (subject to availability). Students will be charged
are required at the start or end of a For arrivals during high season (as noted on the Price List), availability can only be guaranteed within 7 days of arrival (subject to availability). at the weekly rate.
stay, the following rules will apply:
Extra nights are ONLY available as an extension to a booking and cannot be made as a stand alone booking.
Once confirmed, the booking is guaranteed and is subject to EC’s standard Terms and Conditions for EC Accommodation.
Additional nights will only be offered at the approved Additional Night Rates.

SPECIAL REQUESTS
Please use the space below for extra information and special requirements
Do you smoke? Yes No
(allergies, medical conditions, dietary requirements etc)

A non-smoking family? Preferred Mandatory

Are you vegetarian? Yes No

A non-pet family? Preferred Mandatory

PLEASE NOTE: By providing information concerning your health and medical status you consent to
Are you alergic to pets? Yes No
EC using this information as set out in our Privacy Policy and the Terms and Conditions. EC will aim
to accommodate special requirements, however certain requests may not be possible or may incur
A family without children? Preferred Mandatory additional charges. All special requests are subject to availability and confirmation.

PAYMENT
I declare that all information provided in this application form is correct and that I
Who will be paying for Direct payment by me/parent/company have read and understood, and agree to be bound by the Terms and Conditions of
your course? enrolment as set out in this document and on the EC website at www.ecenglish.
Payment via my agent com I understand that acceptance into any course at EC is subject to meeting
the course’s entry requirements and submitting the required payment of fees a
Payment through a sponsor
minimum of 14 days prior to the commencement date of the course.
An enrolment fee will be added to your invoice and the amount falls due when the booking is Signature
confirmed, if you are paying via your agent, please settle the payment directly with him or her.

OPTIONAL STUDENT INSURANCE

Would you like to purchase student insurance? Yes No

AUSTRALIA & NEW ZEALAND ONLY Date

If you plan to study on a Student Visa in Australia, you must have a valid OSHC
policy to cover the duration of you visa and/or stay in Australia.
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The privacy of your information is extremely important to us. We will only ask for
Would you like EC to arrange your OSHC policy? Yes No and use your personal information for the purposes set-out in our Privacy Policy
and in accordance with data protection legislation. For more information please
COVER TYPE Individual Couple Family visit www.ecenglish.com/en/privacy-policy.

EC English Australia Pty Ltd, Trading as EC English, ABN: 33627691696, CRICOS Provider Code: 03812F
EC English (New Zealand) Limited, Education organisation number: 6667, NZBN: 9429047108530