embassy summer application form 2013
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7/27/2019 Embassy Summer Application Form 2013
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ApplicationForm
embassysummer.com
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Application orm 2013Fill in all sections o the orm and return via email to your Advisor. Please print clearly in English and in BLOCK letters.
Dont have an Advisor yet? Please go to www.embassysummer.com/book, ll out the orm and you will be assigned an Advisor.
Booking or more than one child? Please ll out a orm or each.
Need help with the orm? Call +44 1273 339 400
About the student
Family name
First names
Date o birth (dd/mm/yyyy)Age
Gender: M F Nationality
Country o birthYour own language
Home address
Country
Zip/post code
Passport number
Mobile number
Telephone (parent)
Parent mobile number
Email address
How did you hear about Embassy Summer?
Who will be paying or your course? Yoursel Parents Company Company name:
What is your present level o English? Beginner Elementary Pre-intermediate Intermediate Upper-intermediate Advanced ProcientWill you be applying or a visa? Yes No
Course and accommodation options
Please check that the accommodation options are available in the centre o your choice (see page 4 o this orm)
There is space below or you to add a second centre i you wish.
Preferred centre
CentreAccommodation type: Standard En suite Homestay Residential
Start and nish date
Number o weeks
Second choice
CentreAccommodation type: Standard En suite Homestay Residential
Start and nish date
Number o weeks
Do you smoke? Yes No
Do you have any allergies, medical conditions or special requirements (e.g. allergies, vegetarian)? Yes No I yes, please give details:
StudyCare health, medical and travel insurance
Do you require StudyCare insurance? Yes No, I have alternative cover and do not require StudyCare insurance
Countryper
weektwo
weeksour
weekssix
weekseight
weeksthree
monthsour
monthsfve
monthssix
monthsseven
monthseight
monthsnine
monthsone
year
UK 8
USA 96 139 194 244 337 417 503 581 660 739 818 962
Canada 14
Australia* 99 197 296 395
Currency
UK: GBP Canada: CAD USA: USD Australia: AUD
*The Australian Government requires all overseas students studying on a Student Visa to have Overseas Student Health Cover (OSHC).
It is important that your cover is maintained or the duration o your program/s. The ee or OSHC is payable at the time you conrm your enrolment.
Discount rates apply or two years or more (Administration ee included). Full list o prices available online at embassyenglish.com
University
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Airport transfers
We recommend that you book fights only ater your course is conrmed. I you dont have fight details at this stage you can send these to us later.
Do you require transers to and/or rom the airport (available as listed in the tari)? Arrival only Departure only Both ways Not required
Arrival dateTime
Departure airport
Arrival airport
Flight no.
Departure dateTime
Departure airport
Arrival airport
Flight no.
Payment method
Payment is made in two installments. First a small enrolment fee then the full balance. There are two ways you can make a payment,
by credit card or bank transer. Our preerred method is by credit card. I you choose this our advisor will send you a secure online payment link.
I you wish to pay by bank transer your advisor will send you our bank details.
Enrolment fee
This is taken at the time o booking. No money will be charged until your place is conrmed. I no places are available, we will provide alternatives,
or reund your money. Only when your place is conrmed and you proceed with the booking, does this ee become non-reundable.
Country UK USA Canada Australia
Enrolment ee 95 160 160 242
Please tick which applies
Please indicate your preerred method o payment:
Credit card (via secure online link)
Bank transer* *USA subject to a USD25 bank ee, Canada subject to a CAD10
Full balance
The ull balance or your course (and any extras such as transers and insurance) is required at least two weeks beore you arrive.
Please indicate your preerred method o payment:
Credit card (via secure online link)
Bank transer* *USA subject to a USD25 bank ee, Canada subject to a CAD10
Agreement statement o parent/guardian
1 I have read and understood the terms and conditions outlined in the relevant
Embassy terms and conditions o enrolment documentation, including the
cancellation and reund policy.
2 I have read and understood the relevant schedule o costs set out in the current
Embassy price lists and hereby arm that I have sucient unds to pay or all
tuition costs as well as the cost o all ood, accommodation and all other
personal expenses during the ull period o my course at Embassy.
3 I authorise Embassy to take appropriate action in the event o a medical
emergency and I understand that I am responsible or all medical bills incurred.
4 I certiy that all the inormation given by me in this enrolment orm is accurate
and complete.
Signature o applicant
Date
Signature o parent or guardian
Date
Relationship to applicant
I the applicant is under 18, a parent or guardian who, in doing so, agrees to all Embassy conditions, must sign this orm and guarantee the necessary unds or the applicant.
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Tari 2013
14910_SEA 10.12
Centre Accommodation Price One way transer
Australia
Brisbane Homestay 1340 289 (OOL) 144 (BNE)
Surers Paradise Homestay 1340 144 (OOL)
UK LGW LHR STN LTN Central London
BedordStandard 610 150 125 123 72 160
En suite 645 150 125 123 72 160
Bristol En suite 625 230 210 60 (BRS) 160 (BHX) 260
CambridgeHomestay 600 190 165 95 95 165
Residential 685 190 165 95 95 165
CanterburyStandard 615 143 171 171 195 195
En suite 650 143 171 171 195 195
Chalont Standard 640 125 80 160 160 90
ChichesterStandard 610 95 102 160 115 121
En suite 630 95 102 160 115 121
Docklands En suite 685 122 94 122 141 45
Hastings Homestay 575 105 140 150 150 140
KingswoodStandard 615 88 46 168 160 87
En suite 650 88 46 168 160 87
Medway En suite 660 95 116 132 145 122
Mile End En suite 685 122 94 122 141 45
Oxord Headington Standard 645 136 97 150 140 135
Oxord Wheatley Standard 620 136 97 150 140 135
Reigate Standard 620 64 90 117 119 76
South Bank En suite 680 122 94 122 141 45
Southsea En suite 625 106 106 160 115 121
UCL Standard 680 122 94 122 141 45
UxbridgeStandard 640 125 77 160 160 52
En suite 665 125 77 160 160 52
USA
Boston Dean Standard 1180 155 (BOS)
Boston Emmanuel Standard 1180 140 (BOS)
Boston Tuts Standard 1180 140 (BOS)
Fort Lauderdale DowntownHomestay 1154
82 (FLL) 125 (MIA)Residential 1180
Manhattan Pace Standard 1405 170 (JFK)
Los Angeles Cal State Northridge Standard 1200 160 (LAX)
Los Angeles Occidental Standard 1180 160 (LAX)
Los Angeles Woodbury Standard 1180 160 (LAX)
New York Long IslandNot air conditioned 1210 170 (JFK) 210 (EWR)
Air conditioned 1241 170 (JFK) 210 (EWR)
New York Rutgers Standard 1241 210 (JFK) 160 (EWR)
New York Storm King Standard 1154 250 (JFK)
San Diego Homestay 1154 104 (SAN)
San Francisco Santa Clara Standard 1180 160 (SFO)
Canada
Toronto Homestay 1128 132 (YYZ)
Victoria Homestay 1128 100 (YYJ)
BOS - Boston Logan
FLL - Fort Lauderdale
MIA - Miami International
LAX - Los Angeles International
EWR - New York Newark
JFK - New York John F Kennedy International
SAN - San Diego International
SFO - San Francisco International
LGW - London Gatwick
LHR - London Heathrow
STN - London Stanstead
LTN - Luton
BRS - Bristol
BHX - Birmingham
BNE - Brisbane International
OOL - Gold Coast Coolangatta
Canadian airport codes
YYZ - Pearson International
YYJ - Victoria International
US airport codes UK airport codes Australian airport codes
CurrencyAustralia: AUD UK: GBP USA: USD Canada: CAD
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