UC College English Language Centre

IELTS PREPARATION COURSES 2017

Registration Form Personal Details:

1. Family Name: _______________________________________2. Given Names: ___________________________________________________

_____________________________________ 3. Date of Birth: ______/______/______ 4. Nationality: _______________________________

5. Address: ____________________________________________________________________________________________________________

6. Telephone: __________________________ 7. Email: ___________________________________________________________________

8. Have you taken IELTS before? YES / NO

If YES Where?________________________ When? __________________________________ Which module? ACADEMIC / GENERAL

What were your scores? Listening ________ Reading ________ Writing _______ Speaking _______ TOTAL BAND SCORE ________

9. Why do you need to take IELTS? Further education YES/NO

Immigration YES/NO

Employment YES/NO

Other (please specify) _____________________________________________

10. What score do you require? ______________ 11. Which module will you take? GENERAL / ACADEMIC

Course Details: (Please circle answer)

i. Which course do you wish to study?

IELTS EVENING COURSE beginning 3 January 2017 | 7 March 2017 | 23 May 2017 | 8 August 2017 | 24 October 2017

ii. Which modules do you wish to study?

Writing YES/NO

Reading YES/NO

Speaking/Listening YES/NO

Refund Policy:

• If you cancel your application for a course more than 21 days before the start the course, we will refund 100% of your fees. To receive a refund, you must

advise the University in writing of your decision.

• If you cancel your application for a course less than 21 days before the start of the course, we will refund 60% of your fees.

• If you cancel your application for a course once the course has commenced, no fees will be refunded.

Declaration:

I declare that the information I have supplied on this form is, to the best of my understanding and belief, complete and correct.

I have read and understand the above refund policy.

Signature: __________________________________________________ Date: _______________________________

Disclaimer: The UC College undertakes to provide preparation for the IELTS test over the four weeks of the course in classes of 5 to 20 students, but cannot take

responsibility for individuals’ final test results.