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English Language Courses
Student Application Form

Personal Details:

Family Name	:
Given Name(s)	:
Date of birth	:	(dd/mm/yyyy)
Gender	:	Male Female
Address in your country	:
Country	:
Postcode	:
Nationality	:
Email	:
Phone 1 in your country	:
Phone 2 in your country	:
Phone 1 in Australia	:
Phone 2 in Australia	:
Mobile	:
Address in Australia (if known)	:
Country of Birth	:
Passport Number	:
Emergency Contact Details	:
First Language	:
Other Language(s)	:
Occupation	:
Are you a permanent resident?	:	Yes No
Visa type	:	Tourist Working Holiday Student Visa Other
How did you hear about this school?	:	(if other) (agent contact details if applicable)

Educational Background:

Name of Highest Qualification	:
Intended Further Studies	:

English Proficiency:

What is your present level of English?	:	Elementary
		Pre-Intermediate
		Intermediate
		Upper-Intermediate
		Advanced
If you have completed an English proficiency test (eg. IELTS, TOEFL, Cambridge), what is your English Language Proficiency score? (Please specify the test type.)	:

Application Details:

Application submitted by	:	Self Agent
Agent's contact details	:

Which level of General English will you begin with?	:	Elementary
		Pre-Intermediate
		Intermediate
		Upper-Intermediate
		Advanced
		+ Introduction to IELTS exam? + Introduction to Cambridge exam?

Course Start Date	:	(dd/mm/yyyy)
Course Finish Date	:	(dd/mm/yyyy)

Other:

What will you do when you finish this course?

Further study
(please specify if further study)
Travel
Return Home
Work
Other

Airport Pickup and Accommodation:

Do you wish to be met at the Airport?	:	yes no
Flight Number	:
Arrival Date	:	(dd/mm/yyyy)
Arrival Time	:
Do you require accommodation service? (If yes, we will contact you again to choose the right accommodation for you)	:	yes no
Start Date for Accommodation	:	(dd/mm/yyyy)
Type of Accommodation	:	Homestay Hostel Other
Any other comments or enquiries?	:

Click here for Lyceum's Terms and conditions of enrolment, cancellation and refund

All students must read and agree to the conditions of enrolment, cancellation and refund as stated by Lyceum English Language Australia. I have read, understood and agree to the terms and conditions of enrolment, cancellation and refund as stated by Lyceum English Language Australia.

Date of Agreement

(dd/mm/yyyy)

Payment Details

All payments must be received 30 days before your course start date.

When we receive your application we will confirm your place. You can then send us your full fees in Australian dollars by sending a Bank Draft/Bank Cheque/International Money Order. Or you can deposit directly into our bank account, as described in the how to enrol page.

If you are already in Australia payment can be made by credit card, debit card or cash.

Thank you for choosing Lyceum English Language Australia.

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English Language CoursesStudent Application Form

Payment Details

English Language Courses
Student Application Form