PHOTOGRAPH
APPLICATION
FORM
PLEASE WRITE IN CAPITAL LETTERS
ACADEMIC SUBJECT COURSES:
EAT INTENSIVE ENGLISH COURSE
EAT IGCSE COURSE
EAT A LEVEL COURSE
START DATE:
END START:
PREPARATORY COURSE
2. SUBJECT CHOICE (please tick the appropriate boxes)
SUBJECTS TO CHOOSE FOR ACADEMIC SUBJECT COURSES
Please choose 4 subjects from the list below according to your course.
SUBJECTS
maths
further maths
chemistry
physics
law
economics
business studies
politics and government
English
French
German
Spanish
Latin
Russian
Chinese
Italian
psychology
sociology
information technology
history
geography
religious studies
drama
media
elementary
upper intermediate
pre-intermediate
advanced
LEVEL OF ENGLISH
total beginner
intermediate
Results of any English qualifications/examinations taken, with names, dates and grades:
_______________________________________________________________________________________
3. PUPIL INFORMATION (please write in capital letters)
student’s surname: __________________________
first name:_____________________________
known as: _________________________________
gender: male
nationality: ________________________________
date of birth: ____ / ______ / _____
female
languages spoken: ___________________________________________________________________________

London International Study Centre Ltd 2010 E-mail: [email protected] Web: www.londonisc.com
392-394 Ewell Road, Surbiton, KT6 7BB, United Kingdom Tel: +44 (0) 20 8390 8810 Fax: +44 (0) 20 8390 4775
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student’s address:
_________________________________________________________________________________
_________________________________________________________________________________
tel: _____________________________________
fax:
_____________________________________________
e-mail: __________________________________
mobile: _____________________________________________
VISA APPLICATIONS ONLY
passport number: ____________________________
place of issue: ___________________________________
date of issue: ________________________________
expiry date: _____________________________________
How did you hear about London International Study Centre?
______________________________________________________________________________________________
ADDITIONAL INFORMATION
If there is any additional information about your son/daughter that would be useful for LISC to know, please give the
details below: (e.g. personality, hobbies)
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
How long is your son/daughter going to study in the UK? ______________________________________________
Will you need our help in school/college/university selection for your son/daughter in the future? YES/NO (please circle)
If yes, please provide more details: ________________________________________________________________
TRANSPORT
Your son/daughter may travel by any form of public transport:
alone
with an adult
with another student
With the permission of LISC personnel my child may travel in a motor vehicle driven by an adult with a valid driving
licence and motor insurance
(It is important to tick this box if you wish the host family to be able to carry your child in their car)
OVER 14 ONLY (subject to the permission of the host family)
My child may go out alone during daylight hours
S/he may travel away from the local area with friends of the same age or older during daylight hours
S/he may travel alone on local transport
OVER 16 ONLY
My child may travel alone outside the local area
S/he may go out in the evening either alone or with friends
S/he should return in the evening to the host family by ________ (please state time)
MEDICAL INFORMATION
Does your child suffer from any medical issue, illness, allergy or injury?
___________________________________________________________________________________________________
Does your child have any special dietary requirements?
___________________________________________________________________________________________________

London International Study Centre Ltd 2010 E-mail: [email protected] Web: www.londonisc.com
392-394 Ewell Road, Surbiton, KT6 7BB, United Kingdom Tel: +44 (0) 20 8390 8810 Fax: +44 (0) 20 8390 4775
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4. FAMILY INFORMATION (please write in capital letters)
father’s first name: _______________________
father’s surname:___________________________________
profession:
address (if different from the pupil): ____________________
______________________
___________________________________________________________________________________________________
business tel: ______________________________
home tel: ______________________________________________
business fax: ______________________________
home fax: ______________________________________________
mobile: __________________________________
e-mail: _________________________________________________
mother’s first name: _______________________
mother’s surname:____________________________________
profession: ______________________
address (if different from the pupil): ______________________
__________________________________________________________________________________________________
business tel: ______________________________
home tel: _________________________________________________
business fax: ______________________________
home fax: ________________________________________________
mobile: __________________________________
e-mail: __________________________________________________
Who should be contacted in case of EMERGENCY (please tick as many as necessary):
father
mother
both
other
(If other, please give name and contact details): __________________________________________________________
_________________________________________________________________________________________________
5. PREVIOUS RECORDS (please write in capital letters)
Previous schools, with dates: _________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Has the student ever been asked to leave any of the previous schools – if so, please briefly describe the
circumstances:_________________________________________________________________________________
_____________________________________________________________________________________________
Is there any evidence or family history that the pupil has any learning difficulties or special educational needs:
___________________________________________________________________________________________
(Please note that this information will not effect a successful outcome of your application.)

London International Study Centre Ltd 2010 E-mail: [email protected] Web: www.londonisc.com
392-394 Ewell Road, Surbiton, KT6 7BB, United Kingdom Tel: +44 (0) 20 8390 8810 Fax: +44 (0) 20 8390 4775
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6. STUDENT'S STATEMENT (to be completed by STUDENT with NO help)
NAME OF STUDENT:___________________________________________________________________
a. If you can, please write about yourself, your family and friends, your education and work experience your
interests and hobbies.
Please do not worry if you are unable to do so! We are here to help you with your English!
We are confident you will be able to complete this section at the end of the course!
b. If you can, please write what you would like to do in the future.

London International Study Centre Ltd 2010 E-mail: [email protected] Web: www.londonisc.com
392-394 Ewell Road, Surbiton, KT6 7BB, United Kingdom Tel: +44 (0) 20 8390 8810 Fax: +44 (0) 20 8390 4775
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7. CHECKLIST
FORM SECTIONS
(please tick once completed)
1. COURSE CHOICE
4. FAMILY INFORMATION
7. CHECKLIST
2. SUBJECT CHOICE
5. PREVIOUS RECORDS
3. PUPIL INFORMATION
6. STUDENT'S STATEMENT
PAYMENTS
(please remember these payments need to be made with an application form – by cheque, bank transfer or a card payment at ww.londonisc.com )
REGISTRATION FEE OF £100 PAID
REFUNDABLE DEPOSIT PAID
DOCUMENTS
(please tick when attached to the application form)
COPY OF PASSPORT
COPY OF VISA (IF APPLICABLE)
COPIES OF PREVIOUS SCHOOL REPORTS
DECLARATION
(We / I) confirm that, to the best of (our / my) knowledge, the above information is accurate and that (our child’s / my)
admission to the centre is dependent on this being so. I confirm my child has not had help in completing the statement.
I have read and accept the terms and conditions and enclose a registration fee (plus VAT) with this application form.
signature of father: _______________________
signature of mother: _________________________
name in print: ___________________________
name in print: ______________________________
date: ___________________________________
date: ______________________________________
I HAVE READ AND AGREED TO LISC TERMS & CONDITIONS.
(Please contact us if you need any help with calculating the total course price. Thank you.)

London International Study Centre Ltd 2010 E-mail: [email protected] Web: www.londonisc.com
392-394 Ewell Road, Surbiton, KT6 7BB, United Kingdom Tel: +44 (0) 20 8390 8810 Fax: +44 (0) 20 8390 4775
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