First Name

Last Name

Mr /  Mrs  /  Miss  /  Dr  /  Professor

E-mail

Date of Birth                       Age

Male / Female

Address                                                                                                                 

City

State

Zip code

Country

Phone (H) (         ) (          )

                  Country    city

Phone (W) (         ) (        )

                 Country   city

Fax  (         )  (        )

        Country   city

Nationality

Passport No

Native language

Occupation

Academic Institution / Employer

Program options (circle one):

       Total Program (Tuition, Accommodation, Insurance, Activities etc)      /      Tuition and Accommodation Only      /       Tuition Only

Program Location (eg Perth)

Program Title (eg General)

Program Intensity (eg Intensive)

Program Date (eg Mon, Jun 10)                        to (eg Fri, Aug 30)

Program Duration (eg 12 weeks)

Optional Course:

No. of  weeks:

What is your current level of English? Beginner /  Elementary /  High Elementary /  Intermediate /  High Intermediate /  Advanced  /   High Advanced

Previous English Language Studies

Dates (eg May 2000  to  May 2001)

Where (name of institution)

Hours per week

Level

Are you receiving credit transfer for this program from your college or university?    Yes   /      No            If yes, how many credits? 

What other languages have you studied?

How did you hear about this English language program?

Have you participated in another WorldLink Language Program? (eg Spain, China, Italy)

Accommodation (eg Family)

  Double Share   /   Single

No. extra nights:

Accommodation: from Sunday (eg Jun 9)                                                  to Saturday (eg Sept 1)

For shared accommodation:  Do you smoke?   Yes  /   No

Do you prefer to live in a smoke-free room or family?   Yes  /   No

Is there anything we need to know to find you a suitable host family (eg diet, medical problems, allergy, dislike of certain pets)?

Remarks (eg Joint Application – state name of joint applicant, / Re-enrollment)

Person to contact in case of emergency

Name

Relationship (eg father)

E-mail

Phone (H) (         ) (          )

                  Country   city

Phone (W) (          ) (         )

                  Country     city

Fax  (          )  (         )

         Country     city

Application Fee of  AUD $170 / Late Fee of $250

Date paid:

Method of Payment

Bank transfer/ Bank Check / Money Order

Name of Bank

Program Fee

Deductions

WLE Alumni / Joint Application / Other

Extras

Optional Course / Extra nights

Total Program Fee  (include deductions and extras):                                                            Note: Bank charges must be paid by the Applicant

I agree that:

The above information is true and documents given in support of my Application are complete and correct.

____________________________________________________________                         _______________________

Signature of Student / Parent or Guardian for applicants under 18 years old.                      Date

Comprehensive information on WorldLink Education's English Programs in Australia, including Fees, Features and How to apply guide

are available at www.wle-australia.com

For general questions, e-mail info@wle-australia.com  For questions regarding application, e-mail admission@wle-australia.com

Or contact your nearest WorldLink Education Office