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Online Application Form

PERSONAL DATA Mr Ms Family name: First name(s): Date of birth: Mother tongue: Contact address: Permanent address: (optional) Daytime telephone: (optional) Fax number: (optional) Evening telephone: (optional) E-mail:   EDUCATION / QUALIFICATIONS Please list University/College, Field of Studies, Graduation Date, Degree FOREIGN LANGUAGE PROFICIENCY Please list Language(s) spoken and Level respectively (fluent, good, simple, basic) TEACHING EXPERIENCE Please list School, Duration, Age Group, Teaching Level, Course Book(s), other Subjects Taught WORK EXPERIENCE (other than teaching) Please list Employer, Duration, Position HOBBIES / INTERESTS (Optional) DECLARATION I swear that I knowingly have not made any false statements in this application form. I understand that the giving of false information may result in my expulsion from the CELTA course.   HOUSING ASSISTANCE I would like to have arranged accommodation for the duration of the course: Yes No If yes, type of accommodation requested:      -select type of accomodation- Hotel, single (no meals incl.) — $150/week* Student Residence, single (self-catering) — $80/week* Flat, single (self-catering) — $95/week* Flat, double (self-catering) — $75/week* * Please note that these are approximate costs and are subject to change and availability. Accommodation details will be confirmed upon course acceptance. and dates required:   PREFENCES Do you smoke? Yes No   Do you have any allergies? Yes No If yes, please give details:   Do you have any special needs? Yes No If yes, please give details:   AIRPORT PICKUP Do you require pickup from the airport? Yes No