InTuition Languages Enquiry Form 2015 .pdf
Nom original: InTuition Languages Enquiry Form 2015.pdf
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Please provide as much information as you can to help us place you with the right host
teacher and family
Date of birth
50 Avenue des Ternes
Current occupation /
Next of Kin Details – for emergency contact
Course Format: Please select
If two-to-one: Name of other student
Please note: each participant must complete a form
Course Content: Please select
Professional English Training
For General English with Exam Preparation: Exam to be taken
For non-English language courses: Please select course option
Number of lessons per week (each lesson is 60 minutes in length): Please select
Course Objectives: Please outline your course objectives, including any particular skills or
content you want to focus on
I want to improve my professional english to be better in my job. I want to have more impact in my
pitch, presentation and email in english. I also want to be fluent in a discussion.
Course Dates Please note: all course run Sunday PM – Saturday AM
Please indicate your existing knowledge of English:
Written: Please select
0 = No knowledge
4 = Mid-intermediate
Spoken: Please select
1 = Basic knowledge
5 = Upper-intermediate
2 = Elementary
6 = Advanced
How long have you been studying English? Please select
Which course books are you currently using? Please outline
What is your native language?
What other languages do you speak fluently?
7 = Fully proficient
Host Accommodation Details
Prestige Option (Private Bathroom supplement): Please select
Smoking: Do you smoke? Please select
If yes: how many cigarettes / cigars do you smoke per day?
Would you prefer to stay with a non-smoking family?
Special Requests: Please outline any special accommodation requirements you have
Interests and hobbies: This is very important. We try to match you with a host teacher / family
with similar interests and hobbies. Please outline in some detail.
I'm passionate about sports in general : football, rugby, tennis, horse riding, etc... I'm also kind of
new technologies, innovation, startup and entrepreneurship. I love trips, and I love discuss with
others people in general.
Special Remarks: dietary needs, illnesses, diability (learning, behavioural or physical), allergies,
special likes and dislikes, etc
I eat without gluten but it isn't mandatory.
Please indicate your three most-preferred study locations. We always try to match you to your preferred location but
compatibility with the teacher overrides choice of location.
1 Preference: Please select
2 Preference: Please select
3 Preference: Please select
I require transfers:
UM (unaccompanied minor) service required
My local airport in my home country is:
If applicable: I have already made travel arrangements, and the details are as follows:
Included: Full board family accommodation (for 6 nights); tuition for the chosen amount of lessons and use of
published course materials; certificate of attendance; student helpline and educational support.
A Young Learner Supplement applies to courses for students aged under 18.
Airport transfers are obligatory for Young Learner courses.
Excluded: Airport welcome service, incidental expenses and insurance.
Please return your completed form to email@example.com