1. education
2. school

Application form 2015/16
Please print clearly in English and in BLOCK letters and return your application to your local representative or directly to the Admissions Centre.
Please tick boxes where appropriate. Alternatively you can book online at bellerbys.com/admissions/apply-now. Please note all sections are compulsory.
We will be unable to issue an offer unless we have full details of the student applying for the programme.
Local representative information
Representative name
Branch
Student Details *Denotes mandatory field – do not leave blank
Family Name*
Title*
Given Names*
Date of Birth* (dd/mm/yyyy) Age*
F
Gender*: M
Nationality*
Home Address*
Country*
Country of normal residence (if different from above)*
Country of Birth*
Zip/Post Code*
Passport number*
Religion
Expiry date*
Email*
Home Telephone Number*
Mobile Telephone Number*
Parent/Guardian Details *Denotes mandatory field – do not leave blank
Name*
Relationship to student*
Home Address* (if different from above)
Country*
Zip/Post Code*
Email (please provide in order for the College to send Academic Reports, etc.)*
Home Telephone Number*
Mobile Telephone Number*
Medical/Disability/Special Needs
Do you have a disability, impairment or long-term medical condition which may affect your studies?
If yes please indicate the area/s of impairment:
Hearing/deaf
Yes
No
Learning difficulties
Physical
Mental illness
Mobility
Medical condition and supporting requirements (please provide details)
Previous Education Please give details of your current or most recent school, college or university. Please attach certified copies of all academic transcripts or reports (translated into English)
Name and address of school/college/university
Country
Telephone/Fax
Date exams are due to be taken (dd/mm/yyyy) Progression *Mandatory field – do not leave blank
What is your proposed career/university degree choice?*
Centre For courses taught by centre please check the prospectus. Course availability may vary. Check our website for the latest updates
Which centre would you like to study at?
Brighton
Cambridge
London
For GCSE Pathway Programme please see next page
Oxford
English Preparation Courses English levels will be reassessed upon arrival – study plans offered may be altered accordingly. For applications under Tier 4 of the points-based visa system
a score from a secure English language test may be required
Current level of English
IELTS
Pearson
Completion of Study Group English Test
Other, please specify:
Requested length of English Language Preparation
1 term
2 terms
3 terms
not needed
When do you wish to start your English course?
Jan 2015
Apr 2015
Jun 2015
Sept 2015 Jan 2016
Pre-GCSE (Brighton only)
Summer Courses
Bellerbys Summer – see separate application form on bellerbys.com IELTS Express (Brighton only)
Academic Course selection For GCSE Pathway Programme see next page
1 Year GCSE (3 terms Sept only)
1 Year GCSE (4 terms Jan start Brighton, Cambridge, Oxford)
A Level (3 terms Sept only, Brighton only)
A Level (5 terms – Jan All, April Brighton only)
A Level subject choices: 1.
2.
A Level (6 terms Sept entry) 3.
Would you like to join the Oxbridge preparation group?
Yes
University Foundation subject routes:
Business, Finance & Management
Business with Law
Management & Computing Systems
Media
Engineering and Computer Science
Art & Design
Humanities
When do you wish to start your academic course?
Law
Jan 2015
Apr 2015
No
4.
Sept 2015
Would you like to join the Pre-Medical school group?
Yes
Business with Marketing
Science & Pharmacy
No
Chemical Engineering
Extended Foundation (Brighton only, 4 terms)
Jan 2016
Higher education course (London only – Foundation course referenced is Business, Finance & Management)
Which course will you be applying for?
Foundation + Undergraduate Year 1
When do you wish to start your academic course?
BELL-APP-I
Jan 2015
April 2015
Undergraduate Year 1 (Sept and Jan)
Sept 2015
Jan 2016
Pre-Masters (1 term)
Pre-Masters (2 terms)
GCSE Pathways
Taught at Bellerbys College Brighton
EPP English
levels will College
be reassessed
upon arrival – study plans offered may be altered accordingly.
Centre
– Bellerbys
Brighton
Do you require EPP?
Yes
No
Current level of English
If yes:
June 2015
IELTS
September 2015
Completion of Study Group English Test/Password Test (China only)
TOEFL iBT
Start dates 2015/16
English Preparation for Pathways (EPP)
Other, please specify:
1 Term only for entry in Pathway Discovery Programme (Year 9) and Academic Pathway Programme (Year 10)
Summer term two begins: Monday 15 June 2015
Summer term two ends: Friday 14 August 2015
Autumn term begins: Monday 16 September 2015
Autumn term ends: Friday 18 December 2015
Pathway Discovery Programme (Year 9) Term dates for September 2015 entry
Autumn term begins: Wednesday 16 September 2015
Autumn term ends: Friday 18 December 2015
Spring term begins: Monday 11 January 2016
Spring term ends: Friday 1 April 2016
Summer term begins: Monday 18 April 2016
Summer term ends: Friday 17 June 2016
Term dates for January 2016 entry
Spring term begins: Monday 11 January 2016
Spring term ends: Friday 01 April 2016
Summer term one begins: Monday 18 April 2016
Summer term one ends: Friday 17 June 2016
Summer term two begins: Monday 20 June 2016
Summer term two ends: Friday 19 August 2016
Academic Pathway Programme (Year 10) Entry in January 2015 and September 2015
Autumn term begins: Wednesday 16 September 2015
Autumn term ends: Friday 18 December 2015
Spring term begins: Monday 11 January 2016
Spring term ends: Friday 1 April 2016
Summer term begins: Monday 18 April 2016
Summer term ends: Friday 17 June 2016
Entry date selection When do you wish to start your academic course?
Year 9 Pathway Discovery and Year 10 Academic Pathway
Tick the start date you are interested in
Sept 2015
Jan 2016
Year 11 Entry September only Academic Pathway
Tick the start date you are interested in
Sept 2015
Pathways selection Refer to pages 6 and 7 of the Bellerbys College GCSE Brochure
Year 9 Entry
Tick the Pathways you are interested in
Science and Engineering
Business and Economics
Creative Arts
Humanities
Global
Young Oxbridge
Creative Arts
Humanities
Global (select from
Year 10 and Year 11 Entry
Select your chosen Pathway (choose one pathway only)
Science and Engineering
Business and Economics
Young Oxbridge (select from
French or
Spanish and
History or
History or
Geography)
Geography) Pathway Programme Options Year 10 (and Year 11†) Please select 3 choices from the subject options below
Once you have chosen your Pathway for Year 10 please select 3 more subject options from the list below. For the Young Oxbridge Pathway choose only two options from the list below.
Art
French
Economics
History
Drama
ICT
Geography
Psychology
Business Studies
Global Perspectives
The option of English+ and / or Study Periods will be discussed with students on arrival in centre
For Year 11 Entry please refer to page 16 of the Bellerbys College GCSE Brochure which can also be found on www.bellerbys.com
†
Spanish
Accommodation and welfare
Accommodation type
Bellerbys campus
Homestay (sharing) Brighton
Cambridge
London
Oxford
Homestay (single) Brighton
Cambridge
London
Oxford
Homestay plus (sharing, under 16)
Brighton
Cambridge
–
Oxford
By ticking the Homestay plus option you understand and agree that where homestay/lodgings have been arranged for a child who is under 16 on arrival, checks and monitoring
will be carried out by both the college and the local authority.
Homestay plus (single, under 16)
Brighton
Cambridge
–
Oxford
By ticking the Homestay plus option you understand and agree that where homestay/lodgings have been arranged for a child who is under 16 on arrival, checks and monitoring
will be carried out by both the college and the local authority.
Homestay extra (private bathroom)*
Brighton
Cambridge
London
Oxford
Homestay en-suite – Regular (single)
–
Cambridge
–
–
Homestay en-suite (sharing)
–
Cambridge
–
–
Homestay en-suite linked (sharing)
–
Cambridge
–
–
GCSE Pathway (single, en-suite, full board)
Brighton
–
En-suite catered (sharing, half board)
Brighton
–
En-suite catered (single, half board)
Brighton
En-suite catered (sharing, half board, 18+)
Brighton
–––
En-suite catered (single, half board, 18+)
Brighton
–
–
London
Cambridge
–
–
London
Oxford
––
En-suite catered (single, half board, under 18)
–
Cambridge
–
–
En-suite self-catering (single, 18+)
–
Cambridge
En-suite self-catering (sharing, 18+)
–
–
London
–
En-suite self-catering (shared room but with single occupancy)
–
–
London
–
En-suite studio flat self-catering
–
Cambridge–
–
En-suite one bedroom flat self-catering
–
Cambridge–
–
London
Oxford
*Limited availability
Full Board – all meals
Half Board – breakfast and dinner only
Self-catering – no meals
Accommodation not required (over 18s only)
Do you smoke?
Yes
No
Pet preference
Dogs
Cats
No pets
Don’t mind/No preference
Do you have any special dietary requirements (eg halal, vegetarian, no pork, food allergies)?
Do you have any medical issues (medical conditions or allergies that require attention/notification and any prescribed medicine taken on a regular basis)?
This facility will be reserved only when enrolment has been confirmed with full confirmation payment. NB: it is a condition that a minimum of one term’s
written notice is given if you wish to leave or change accommodation.
Airport collection
Airport collection for all students under the age of 18 is mandatory and will automatically be arranged unless specified otherwise below; all students under the age of 18 who
do specify otherwise must be accompanied by parents or a relative approved by parents (in which case proof of approval will be required). Students should arrive 24 to 48 hours
prior to commencement of the course. Flight details including date and flight number should be sent to the UK Admissions Centre as soon as possible to arrange
for airport collection.
Do you require airport collection? (This will be invoiced as an extra charge where applicable)
From which airport?
Heathrow
Yes
Gatwick
No
Stansted
Student insurance
You are required to have an adequate insurance policy in place as part of our Terms and Conditions. If you would like to purchase our StudyCare Insurance priced at £8 per week
(inclusive of Insurance Premium Tax) please tick YES box below. Otherwise please provide proof of alternative adequate insurance cover.
Do you require StudyCare Insurance?
Yes
No ( Please tick) If no, please provide proof of alternative adequate cover when you confirm your place
Payment procedure and start dates
• All outstanding fees are payable one month before the start of term and tuition and accommodation cannot commence before outstanding fees are paid in full.
•O
ne term’s notice must be given to withdraw from tuition and/or accommodation.
•F
ees are normally reviewed in September each year, but in exceptional circumstances may be revised at anytime. Notice of any change will be given in advance.
•T
uition fees do not include IELTS English classes for A Level (£500 per term), exam fees, text books.
•A
ll fees for one or two term courses must be paid in full in advance.
Confirmation payment A confirmation payment must be received by Bellerbys College before enrolment papers or a visa letter are issued
Non-refundable enrolment fee
£160
Fees in advance (deducted from the balance of fees)
£500
Deposit (refundable at the end of course)
£1,000
Total Confirmation payment (to which must be added the appropriate StudyCare insurance fee)
£1,660
Start dates for Bellerbys Brighton, Cambridge, London, Oxford
Term Dates 2015
Spring term
Term begins: Monday 5 January
Term ends: Thursday 27 March
Half term in Autumn and Spring terms are 2 or 3 days. Dates are decided by each centre.
Summer term one
Term begins: Monday 13 April
Term ends: Friday 12 June / Friday 26 June for ELPP and Pre-Masters
Summer term two
Term begins: Monday 15 June / Monday 29 June for ELPP and Pre-Masters
Term ends: Friday 14 August / Friday 4 September for ELPP and Pre-Masters
Half term to be advised by each centre
Autumn term
Term begins: Wednesday 16 September
Term ends: Friday 18 December
Half term in Autumn and Spring terms are 2 or 3 days. Dates are decided by each centre.
Term Dates 2016
Spring term
Term begins: Monday 11 January
Term ends: Friday 1 April
Summer term one
Term begins: Monday 18 April
Term ends: Friday 17 June / Friday 1 July for ELPP and Pre-Masters
Summer term two
Term begins: Monday 20 June / Monday 4 July for ELPP and Pre-Masters
Term ends: Friday 19 August / Friday 9 September for ELPP and Pre-Masters
Autumn term
Term begins: Wednesday 14 September
Term ends: Friday 16 December
Half term in Autumn and Spring terms are 2 or 3 days. Dates are decided by each centre.
Payment details
Once an offer of a place has been accepted we require: a deposit of £1,000; £500 advance payment of fees; and, £160 enrolment fee. You will also be required to pay in advance the
StudyCare insurance fee unless you have provided proof of alternative cover. Payment can be made either by sterling bankers draft, Western Union, credit card, debit card or by direct
bank transfer. Our bank details are as follows:
Bank address: NATIONAL WESTMINSTER BANK, HOVE TOWN HALL BRANCH 103 CHURCH ROAD, HOVE BN3 2BS, UNITED KINGDOM
Account name: BELLERBYS EDUCATIONAL SERVICES LTD
Sort code: 53-61-02
Swift number: NWBKGB2L
Iban number: GB94NWBK53610209821392
PLEASE CHECK THAT YOU HAVE:
completed the form in full and checked for accuracy
enclosed proof of alternative insurance policy, if relevant
enclosed full transcript of all your relevant qualifications, translated into English
enclosed evidence of previous academic study in the UK and copies of previous UK visas (if applicable)
for GCSE Pathway Programme, enclosed at least one academic reference from current school
e
nclosed a certificate confirming your English level or the completed pre-arrival English test (the essay section should be hand written)
enclosed copy of valid passport
enclosed a signed declaration form (applicable for students from China and Bangladesh only)
Tuition and accommodation fees
September 2015 – August 2016
Tuition only
Programme
price per term
English Preparation for Pathways (EPP) - 1 term only £7,960
£7,960
GCSE Pathway Discovery Year 9 Entry
GCSE Academic Pathway Year 10 Entry
£7,960
Pre-GCSE£6,410
+
1 Year GCSE £7,740
A Level*+£8,580
IELTS+ English classes for A Levels
£460
£7,120
Foundation Programme Brighton and London
Foundation Programme Oxford and Cambridge
£6,915
+
Extended Foundation
£7,120
English Language Preparation Programme (ELPP)
£6,230
Bellerbys Summer+£950
£2,230
Bellerbys IELTS Express (price per 6 week course)
Higher Education Programmes
price per term
Undergraduate Year 1 (London only)
Pre-Masters (London only)
£6,080
£5,390
+ GCSE, A Level, Foundation, Bellerbys Summer, IELTS Express and IELTS are all subject to additional exam fees. These fees will be charged to your account accordingly.
* A Levels: Some minority A Level subjects (usually Modern languages) are subject to an additional supplement of £500 per term.
Accommodation only
All prices per term
Brighton
Cambridge
London
Oxford
Homestay (sharing)
Homestay (single)
Homestay plus (sharing, under 16)
Homestay plus (single, under 16)
Homestay extra (private bathroom)*
Homestay en-suite – Regular (single)
Homestay en-suite – (sharing)
Homestay en-suite linked (sharing)
GCSE pathway en-suite (single, full board)
En-suite catered (sharing, half board)
En-suite catered (single, half board)
En-suite catered (sharing, half board, 18+)
En-suite catered (single, half board, 18+)
En-suite catered (single, under 18)
En-suite self-catering (sharing, 18+)
En-suite self-catering (single 18+)
En-suite self-catering (shared room but with single occupancy)
En-suite studio self-catering
En-suite one bedroom flat self-catering
Holiday-time room retention (price per week)
£1,640
£2,030
£2,030
£2,390
£2,860
–
–
–
£5,145
£4,320 (on campus)
£5,150 (on campus)
£3,110 (Paris House)
£3,710 (Paris House)
–
–
–
–
–
–
£53
£1,940
£2,330
£2,330
£2,710
£3,170
£2,870
£2,720
£2,325
–
–
£4,500
–
–
£4,500 (Tripos)
–
£3,720 (Tripos)
–
£5,290 (Purbeck)
£6,080 (Purbeck)
£53
£2,300
£2,690
–
–
£3,530
–
–
–
–
£4,010
£4,580
–
–
–
£3,420
£3,960
On request
–
–
£53 (18+)
£1,940
£2,330
£2,330
£2,710
£3,710
–
–
–
–
–
£4,500
–
–
–
–
£3,720
–
–
–
£53
Please note:
1) By ticking the Homestay plus
option you understand and
agree that where homestay/
lodgings have been arranged
for a child who is under 16 on
arrival, checks and
monitoring will be carried
out by both the college and
the local authority.
2) Under 16 year old students
wishing to stay in Homestay
must take the Homestay Plus
option.
3) A
ccommodation fees relate
to term-time only. Holiday
accommodation will be
charged separately – details
are available on request.
* Limited availabilty
Full Board – all meals
Half Board – breakfast and dinner only
Self-catering – no meals
Airport collection
We ask that students arrive 24 to 48 hours prior to commencement of their course. We will arrange to meet students at the airport on arrival and take them to their accommodation.
We will automatically arrange an airport transfer for all students under the age of 18 at the date of their arrival in the UK.
Airports
Brighton CambridgeLondon
Oxford
London Heathrow Airport
£150
£190
£130
£190
London Gatwick Airport
£110
£220
£160
£250
London Stanstead Airport
£260
£120
£180
£260
Please add full contact details of the person collecting you (if you have not requested a transfer and are staying in one of our accommodation options), including mobile phone
and email address
Name
Address
Country
Email
Mobile telephone
Zip/Post Code
Declaration
Undertaking – by the parent, legal guardian or sponsor
I apply to enrol the person named as a student of Bellerbys College. I undertake to pay all tuition and accommodation fees incurred by
the student as they become due in accordance with the Terms and Conditions and, where relevant, either to give the required notice of
cancellation or to pay the required fees in lieu of notice.
By ticking this box I confirm the following:
• I am the parent or legal guardian of the student and have the full and express authority and consent of the student to submit this
application on their behalf.
•A
ll information submitted in the admission process – including this application and any other supporting materials – is factually true
and honestly presented.
• I have advised you of any medicines currently being taken, or any on-going medical condition.
• I give my permission for the administration of first aid and appropriate non-prescription medication to my child.
• I give my consent for you to seek medical, dental or optical treatment when required.
• I understand that I may be subject to a range of possible disciplinary actions should the information I have confirmed above be false.
Full name(please print)
Date
Terms and Conditions
Any offer will be made subject to Bellerbys Terms and Conditions and these can be viewed at bellerbys.com/terms-and-conditions
18777_PEGA Rev 03-15