BODWELL LANGUAGE SCHOOL - REGISTRATION FORM
Personal Information
*
Last name (Family Name)
*
First name
Other name / English name
*
Date of Birth (MM/DD/YYYY)
/
/
*
Sex
M
F
*
Nationality
Address
Emergency Contact
*
Street
*
City
State / Prov
*
Postal Code
*
Country
Name
Relation
Phone
Fax
E-mail
Native Language
*
E-mail
*
Phone
Fax
*
Do you want to purchase medical insurance from Bodwell?
Yes
No
(Some form of medical insurance is mandatory)
Start date of the insurance
(minimum 30 days)
weeks and
days
How do you rate your English ability?
Beginner
Low Intermediate
High Intermediate
Advanced
Study Option 1
START DATE:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
for
weeks
PROGRAMS
SUPER INTENSIVE - 30 hours per week (9:00—4:00)
INTENSIVE - 25 hours per week (9:00—3:00)
SEMI-INTENSIVE MORNING PART-TIME - 15 hours per week (9:00—12:00)
SEMI-INTENSIVE AFTERNOON PART-TIME - 15 hours per week (1:00—4:00)
UNIVERSITY PREPARATION PROGRAM - 30 hours per week (9:00—4:00)
Study Option 2
START DATE:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
for
weeks
PROGRAMS
SUPER INTENSIVE - 30 hours per week (9:00—4:00)
INTENSIVE - 25 hours per week (9:00—3:00)
SEMI-INTENSIVE MORNING PART-TIME - 15 hours per week (9:00—12:00)
SEMI-INTENSIVE AFTERNOON PART-TIME - 15 hours per week (1:00—4:00)
UNIVERSITY PREPARATION PROGRAM - 30 hours per week (9:00—4:00)
Desired Program:
Business
Tourism
TESL
Grammar
Integrated English
Homestay Application
Do you need Homestay?
Yes
No
If yes, please fill in the information below:
How long for Homestay? (minimum 4 weeks)
*
4
5
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45
46
47
48
49
50
51
52
weeks and
0
1
2
3
4
5
6
days
Do you smoke?
Yes
No
List foods you
do not like
to eat
Can you live with other smokers?
Yes
No
List foods you
cannot
eat
Medical condition
and special requests
Would you like to live in a homestay that has:
Yes
OK
No
(If no, list reasons why)
dog
cat
young children
teenagers
another student
more than 2 other students
Airport Pick-up
*
Yes
No
Arrival Date
Arrival Time
Airline & Flight Number
Airport Drop-off
*
Yes
No
Departure date and flight information
** NOTE: If this information is not yet available, please inform us once it is confirmed. To arrange pick up, please inform us a minimum of one week prior to your program start date.
Please Read and Agree to the Below
*
How did you hear about Bodwell Language School?
Friend
Agent
Education Fair
Website
Advertisement
Embasssy
Other
If you are registering through a Bodwell representative:
Representative Name
Telephone
Fax
E-mail
If you require assistance, please click
here
to contact the Admissions Department.