Personal Details Please print clearly in English using CAPITAL LETTERS

Family Name: Email: First Name(s): Address: Date of Birth: Date Month Year Nationality: Phone:

IELTS Preparation Course

Please note that dates and fees may change. Please refer to the ELA website for current information: www.ela.auckland.ac.nz

Evening Course (6 - 8pm) ($635) Start Date: Date Month Year Saturday Course (9am – 1pm) ($440) Start Date: Date Month Year Academic Writing Masterclass (9am - 1pm) ($149) Start Date: Date Month Year

Module General Academic

Agent Details Please fill in the information below if you are using an agent representative Agency Name: Phone: Email

Insurance

All international students are required to have approved insurance while studying in New Zealand. If you already have an approved insurance policy, you will need to provide the ELA with details to waive this fee. Please see www.ela.auckland.ac.nz/insurance

Afternoon/Evening Course ($55) Saturday Course ($55)

IELTS Preparation Materials

Official IELTS Test Practice Book Volume 1 (includes CD) ($60) Official IELTS Test Practice Book Volume 2 (includes DVD) ($60)

Payment options Total amount payable (including course, insurance and materials): $______

Application Form IELTS Preparation Courses

Please either pay in person at the ELA with the documents listed below, or email to enrolment@ela.auckland.ac.nz Application form Passport & valid visa (for e-visas, please print the copy) Insurance certificate (if applicable) If applying by email, we will check availability and advise you of the bank details for online transfers. Terms and Conditions of Enrolment

• No refunds or transfers will be issued once the fee has been paid, unless there are insufficient numbers to

run a course, in which case it will be cancelled, and a full refund issued and applicants advised accordingly. • Classes will not be held on public holidays. • The set text “New Insight into IELTS” is included in the cost of the course. The CDs for this book can be

purchased from the University Book Shop. • You may be asked to produce the ID card which will be provided on the first day of your course when

using the Study Centre computers. • It is a condition of enrolment that students must be 17 years or older prior to commencing this course. • Missed classes cannot be made up or transferred to another course. • No late enrolment is permitted. • This course is designed as a one-off exam preparation course. Students wanting to re-enrol in the course

must seek prior approval from the Academic Manager. • The ELA reserves the right to change these terms and conditions without prior notice

Signature of applicant:

Date: Date Month Year How did you hear about the ELA?

Education agent Internet search ELA website Students at the ELA Education fair Facebook / social media Other (please specify below)

Why did you choose to study at the ELA?

Please send this application to an Enrolments Officer at:

E: enrolment@ela.auckland.ac.nz

The University of Auckland English Language Academy, Level 5, 67 Symonds Street, Bag 163, Private Bag 92019, Auckland, New Zealand

P: (+64) 9 919 7695