UCD English Language Academy

General English Course Application

Personal Details

Title MR MRS MS (circle where appropriate)

Surname(s)
First Name(s)
Nationality
Gender M F (circle where appropriate)
Date of Birth / / /
First Language
Passport Number Please place a
passport sized
Previous ELA Student no yes (circle where appropriate) photograph here

Details of any health issues, allergies, dietary needs or disabilities:

How did you hear about the UCD ELA’s courses?

Contact Details
Correspondence Address Next of Kin details (name, address, mobile, email etc.)
Address

City
Country
Postcode

Telephone
Mobile
E-mail

Present Level of English

Please give details of English language examinations you have taken (e.g. Cambridge):

Are you currently attending an English course? Where?

How many years have you been studying English?

 UCD English Language Academy
General English Course Application

Course Dates and Price

COURSE DATES AND PRICES 2022

Start Dates Select the Breaks Duration Price

date
10 January 2022 Please note that there will be 5 weeks €1,050
university breaks for the
14 February 2022 following dates: 10 weeks €2,000

21 March 2022 *Winter Break 2022 TBC 15 weeks €2,850

25 April 2022 20 weeks €3,600

30 May 2022 25 weeks €4,250
29 August 2022 Registration Fee €75
(includes course book)
3 October 2022 Homestay €245 per week
Accommodation + €60
placement fee
7 November 2022 Airport transfer €80

Price Bank Holidays: Wednesday ,17th March 2022, , Easter Monday ,18th
25 weeks GE +IELTS =€6150 April 2022, Monday,2nd May 2022, Monday 6th June 2022, Monday,1st
IELTS Afternoon classes are available to |General August 2022, Monday ,31st October 2022
English students for shorter terms also. Please contact
us for specific prices.
Agent Name: Discount code:

Accommodation
Will you require Homestay accommodation for the duration of your UCD ELA course?
(Circle where appropriate) Yes No

Length of Accommodation in weeks (minimum stay 4 weeks):

Note: Accommodation is reserved from the Sunday before a course starts up to and including the Saturday night after a course
finish.

Payment Details
Indicate the Method of Payment In te rnat i onal Bank Transfer

I am over 18 years of age and I understand that:

• All course fees (including bank charges) must be paid 2 months in advance of course start date
• Once classes start, fees are non-refundable. Cancellation charges available on request
• UCD English Language Academy terms and conditions apply

Signature: Date:
Please return to: UCD English Language Academy, University College Dublin, Dublin 4, Ireland
Email : ela@ucd.ie Tel : +353 1 716 8763