Use the following form to apply to study at Berlitz Manchester

Your details

TitleMrMrsMissDr
Surname
First Name(s)
Street
City
Country
Postcode/Zip-code

Gender

Male Female 

Telephone
Fax
Email
Nationality
First Language
Date of Birth
Passport Number

Indicate your approximate level

Level:BeginnerElementaryPre-intermediateIntermediateUpper-IntermediateAdvanced

Course Details

Language to study
Start Date
Finish Date
Are you Government Sponsored student?---YesNo

Chosen Course:---General English – Standard ( 15 hours)General English – Intensive ( 20 hours) General English – Super-Intensive ( 25 hours)IELTS Preparation – Standard ( 15 hours)IELTS Preparation – Intensive ( 20 hours)Academic English – Standard ( 15 hours)Academic English – Intensive ( 20 hours)Foundation programmeCrash CourseTotal Immersion

Elective Preference
(Please select 1 for General English – Intensive, or 2 for General English – Super-Intensive):
Preference 1:Not RequiredCommunication skillsBusinessAcademicIELTSCambridge exam preparation
Preference 2:----Communication skillsBusinessAcademicIELTSCambridge exam preparation

Berlitz special programmes:
Would you like to take advantage of Berlitz special programmes:
Not RequiredWork-StudyInternshipDemipair

Accommodation

2 weeks notice is required for Homestay.

Accommodation
Would you like Berlitz to arrange accommodation for you?
Yes No 

What type of accommodation do you require?
Not RequiredHomestayExecutive HomestayStudent ResidentialApartment

Start Date
Finish Date
(Dates must be a Saturday or Sunday)

Any Special Requirements?

Yes No 

Any Special Dietary Requirements?
Not RequiredHalalKosherVegetarian

University Placement Service

Do you want ourUniversity Placement Service (Cost £500): 

Insurance

Insurance is compulsory for staying in homestay. If you already have alternative insurance arrangements and are in homestay, please supply a copy of the policy in English by fax on +44 (0)161 236 4906.

Would you like Berlitz to arrange insurance cover?

Yes No 

Airport Transfer

Would you like Berlitz to arrange an airport transfer for you?Yes No 

If YES, please select your preference:

PLEASE SELECTManchester - one-way - £60Manchester - return - £120Liverpool - one-way - £100Liverpool - return - £200 - Prices are per person

Flight Details (if available)

We cannot confirm a transfer until we have your flight details.

Health

Do you take any medication?Yes No 
If yes, specify:

Do you have any Allergies?Yes No 
If yes, specify:

Do you have any special needs?Yes No 
If yes, specify:
I agree with the Terms & Conditions:  Yes