Surname:

First Name:

as you wish it to appear on your end of course certificate

Nationality

Passport Number

Date of Birth

Course participants must be 18 years or older

Male

Female

Occupation

Native Language

Other languages you speak fluently

Full Address for Correspondence:

Telephone:

Fax:

Email Contact

How long have you been studying English?

Speaking

Listening/Understanding

Reading

Writing

Please give details of any English language examinations you have taken in the past five years and give the scores achieved

For applicants for Preparation for University courses, please give details of your IELTS test results below

Overall IELTS score:

Date of Test

IELTS score for speaking:

IELTS score for listening:

IELTS score for reading:

IELTS score for writing:

Do you want the University of Limerick Language Centre to arrange accommodation for you?

If yes, please choose one of the following:

Any other relevant accommodation information?

Date and time of arrival

Date and time of departure

Where did you hear about the University of Limerick Language Centre?

Please give the name and address of the person to be contacted in the case of an emergency

Conditions of Enrolment

I have read the terms of enrolment?