Limerick Language Centre

First Name: *

Surname: *

Nationality: *

Passport No:

Gender: *

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

Email: *

Phone: *

Course Details: *

GE-20 Standard (Full-time Mornings)

GE-30 Intensive (Full-time Mornings & Afternoons)

GE-20 + 5 Combination (Full-time Mornings + 1-to-1 lessons x 5)

GE-20 + 10 Combination (Full-time Mornings + 1-to-1 lessons x 10)

PET-30 Full-time Mornings + Afternoons (GE-20 + PET-10)

FCE-30 Full-time Mornings + Afternoons (GE-20 + FCE-10)

CAE-20 (Full-time mornings)

IELTS-30 Full-time Mornings + Afternoons (GE-20 + IELTS-10)

AY-IELTS Academic Year

AY-PET Academic Year

AY-FCE Academic Year

AY-CAE Academic Year

GE-10 Part-time Afternoons (1pm-3.30pm)

IELTS-10 Part-time Afternoons (1pm-3.30pm)

PET-10 Part-time Afternoons (1pm-3.30pm)

FCE-10 Part-time Afternoons (1pm-3.30pm)

GE-eves Tues/Thurs Part-time Evenings (7pm-9pm)

FCE-eves Tues/Thurs Part-time Evenings (7pm-9pm)

CAE-eves Tues/Thurs Part-time Evenings (7pm-9pm)

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

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

Number of Weeks

End-of-programme Exam Registration fee for Academic Year programmes (not necessary for EU/EEA students) *

Yes

Not necessary for me (I have EU/EEA passport)

Medical Insurance for Academic Year programmes *

Yes

No

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):

Number of Weeks

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