Limerick Language Centre

First Name(s): *

Family name(s): *

Nationality: *

Passport No:

Gender: *

Date of Birth (mm/dd/yyyy): *

Email: *

Phone (we like to use WhatsApp if possible): *

Course Details: *

GE-20 Standard (Full-time Mornings)

PET-26 Intensive (Full-time Mornings & Afternoons)

FCE-26 Intensive (Full-time Mornings & Afternoons)

IELTS-26 Intensive (Full-time Mornings & Afternoons)

CAE-20 (Full-time mornings)

AY-IELTS Academic Year

AY-PET Academic Year

AY-FCE Academic Year

AY-CAE Academic Year

PET-6 Part-time Afternoons

FCE-6 Part-time Afternoons

IELTS-6 Part-time Afternoons

GE-eves Part-time Evenings

FCE-eves Part-time Evenings

CAE-eves Part-time Evenings

Start date of course (mm/dd/yyyy) *

End date of course (mm/dd/yyyy) *

Do you require an End-of-programme Exam (this is required for non-EU/EEA students who choose Academic Year programmes)? *

Yes

No (I have an EU/EEA passport)

Do you require Medical Insurance (required for non-EU/EEA students)?s *

Yes

No (I am an EU/EEA student)

English Level *

Online Test Result: *

Accommodation Details: *

Do you have any allergies or medical conditions we should be aware of?

Is there any food you cannot eat?

Arrival Date in accommodation (mm/dd/yyyy):

Departure Date from accommodation (mm/dd/yyyy):

Do you require local arrival transfer? *

Yes, I would like your driver to meet me on arrival in Limerick City centre

Yes, I would like your driver to meet me on arrival in Shannon Airport

No, I can go to my accommodation myself

No, I already live in/near Limerick

Arrival Details/Additional Information:

Why do we need your personal information in this application?

We need the above information to book and arrange your English language programme, accommodation and local arrival transfer. We will not share this information with anyone outside of our organisation unless required by law.

You have the right to access this information at any time - I agree to give Limerick Language Centre the above personal information. *

Yes