Applicant Details: Type of Student* Please SelectDirect Student BookingAgency Booking If Agency Booking, please write Agency Name If Direct Booking, please write your Advisor name in Berlitz Manchester Your Details: Student Title* Select Gender* Please SelectFemaleMaleOther Student First name* Student Last name* Student Date of Birth* Student Mobile Phone Number* Student Email Address* Student Full Home Address* City* State/Region Country* Nationality* Passport Number* If you don't have it yet, please write 'to be provided' Do you require a visa to ENTER in the UK?* Please check it before submitting application. To check if you need a Visa for the UK: Click here Please SelectYesNo Language Programme: Face-to-Face classes 15h per week - General English20h per week - Intensive General English25h per week - Super Intensive General English20h per week - General English (15h) + ESP (1h)20h per week - General English + Business English20h per week - General English + IELTS Preparation20h per week - IELTS PreparationPrivate Lessons Online classes 15h per week - General English20h per week - Intensive English20h per week - IELTS Masterclass20h per week - Pre-sessional Academic English6h per week - High intensity English Please state the hours required for private lessons: * Please state the English for Special Purposes (ESP) topic * What is your English Level?* Please SelectA0/A1 - BeginnerA1 - ElementaryA2 - Pre-IntermediateB1 - IntermediaB2 - Upper-IntermediateC1 - Advanced Do you require a final exam?* Please SelectTIE ExamIELTS ExamNot Required Course Start Date (Mondays only)* Number of Weeks* Accommodation: Would you like Berlitz Manchester to arrange accommodation for you?* Please SelectYesNo How many weeks of accommodation? Start Date (Sundays only)* Which type of accommodation do you require?* Please SelectHomestay: Single - Half BoardHomestay: Twin - Half BoardStudent Residence Do you have any special requirements?* Please provide the address you will be staying at during your studies with us* Airport Transfer / Additional Services: Would you like Berlitz Manchester to arrange airport transfer for you?* Please note: The airport transfer cannot be arranged until the full flight details are provided. Please SelectYesNo You will be responsible for arranging your own transport from the airport. Single or return? Please SelectSingleReturn Date of Arrival Arrival Airport Please SelectManchester AirportLiverpool AirportLeeds AirportLondon Airport Departure Airport Flight Number Arrival Time What type of insurance do you require?* If not booked by the school, the student must be booked by a different provider prior entering in the country. Please SelectShort Term insurance - Course DurationAcademic Year InsuranceNot Applicable Learning Needs and Disabilities: Do you have a disability, learning need or medical condition? Please SelectYesNo Please add any further relevant information we should be notified of:* Would you like any additional support to help you with your studies and learning? * e.g. do you need to read large print / read on coloured paper? Next of Kin / emergency contact Note: For students under 18 years of age, a signed parental consent form must be submitted prior to arrival date Full name* Email Address* Does this person speak English?* Please SelectYesNo Their relationship to you* Language spoken* Additional Information: How did you hear about Berlitz Manchester?* Please SelectBerlitz Manchester websiteGoogle / InternetFacebookFriend / Family memberEducation fair / ExhibitionAdvertisementFormer studentAgent Which Agency? Payment Details: Who will pay for your course and your stay in the UK?* Please note that if you are being sponsored by a government/sponsor, institution or employer you must provide a sponsorship letter. Please SelectSelfSponsorFamilyEmployer Details of employer* Details of sponsor* Declaration: I confirm that, to the best of my knowledge, information given in this form is correct and complete. I have read the Terms and Conditions and I understand what they say. Accept terms and conditions Δ