Office Use Only

Date:
S. ID:
Dep:
CD: M: Acc:
English Language Education Registration Form Agent/Data P.
Inv. No.:

Student Personal Details (TO BE COMPLETED IN FULL)

Family Name Name
(as it appears on your passport) (as it appears on your passport)

Title: Mr/Mrs/Ms/Miss Sex: Male Female

Home Address:
Town/City: Province/Region:
Zip/Postcode: Country:
Telephone: Email:
Passport number: Date of Birth (dd/mm/yy) / /
Nationality: Country of birth:
First language: Do you smoke? No Yes
Do you regularly take any medication? No Yes If yes, please give details:
Do you have any medical disabilities/conditions/allergies (e.g. pets)?
Other information e.g. dietary requirements:

Educational Background
Have you previously had a Tier 4 General Student Visa? No Yes If yes please send copy of visa with details of course(s) studied.
What is your level of English? Lower Intermediate Intermediate Upper Intermediate Advanced
Have you taken an International English test in the last two years? (Such as IELTS, TOEFL, CPE, CAE or FCE) No Yes
If Yes, which test? (Please attach a copy of your certificate): Score:
Are you a student? No Yes If Yes, year of study? Subject:

Have you applied to study in the UK after your course at ELE? No Yes If Yes: Undergrad. Post-grad.
Subject: Name of College/University:
Are you working? No Yes Occupation:
Are you a teacher of English? If Yes, at which level? Primary Secondary Tertiary
Have you studied at ELE before? No Yes If Yes, which year and course?

Course(s) at English Language Education

Date from Date to No. of Accommodation
Course(s) applied for (dd/mm) (dd/mm) weeks 1st choice 2nd choice 3rd choice
1 ... ... ...

2 ... ... ...

3 ... ... ...

4 ... ... ...

You should be aware that information about your enrolment, attendance and progress at this establishment may be passed to the UKVI for purposes connected with
immigration.
English Language Education, The University of Edinburgh, Paterson’s Land, Holyrood Road, Edinburgh EH8 8AQ
Tel: +44 (0)131 650 6200 Email: eltcinfo@ed.ac.uk www.ed.ac.uk/english-language-teaching
English Language Education Registration Form
Payment made: Payment method: Who is making payment?:
.Once your application is accepted we will confirm the required Online by ePay Student
pre-payment to be made in order to secure your place. Bank Transfer (attached) Agent
Please see Terms and Conditions regarding cancellation and
amendment charges. https://www.ed.ac.uk/english-language-
teaching/apply/terms-and-conditions

Criminal convictions
Do you have any unspent criminal convictions? No Yes
You are required to indicate whether you have any relevant criminal convictions. Relevant criminal offences include convictions, cautions, admonitions, reprimands, final warnings, bind
over orders or similar involving one or more of those listed below:
• Any kind of violence including (but not limited to) threatening behaviour, offences concerning the intention to harm or offences which resulted in actual bodily harm
• Offences listed in the Sex Offences Act 2003
• The unlawful supply of controlled drugs or substances where the conviction concerns commercial drug dealing or trafficking
• Offences involving firearms
• Offences involving arson
• Offences listed in the Terrorism Act 2006
Convictions that are spent (as defined by the Rehabilitation of Offenders Act 1974) are not considered to be relevant. Applicants who indicate they have a relevant conviction will not be
automatically excluded from enrolling. However, you may be asked to provide additional information relating to your conviction. If you are convicted of a relevant criminal conviction after
you have enrolled, you must inform Reception immediately.

Visa Requirements:
I require a confirmation of Acceptance for Studies (CAS) for a Tier 4 General Student Visa (IELTS for UKVI certificate attached.)
I do not need a visa to study in UK (e.g. EU nationals)
I will apply for a dependant visa
I will apply for a Short Term Visitor Visa: 6 months 11 months
Emergency contact: Name: Tel: Email:

Declaration
I have read the instruction for registration and payment and accept the terms and conditions. I certify that the information I have provided here is
true and correct and understand that the University has the right to withdraw any offer made or cancel any registration if any of these statements
prove to be incorrect. I accept full responsibility for the information I have provided on this form.

ELE would like to send you our newsletter and information about future courses by e-mail. We will not share your details with anyone else. If you do
not wish to receive this information, please email eltcinfo@ed.ac.uk with ‘Unsubscribe newsletter’ in the subject line to unsubscribe.

English Language Education, The University of Edinburgh, Paterson’s Land, Holyrood Road, Edinburgh EH8 8AQ
Tel: +44 (0)131 650 6200 Email: eltcinfo@ed.ac.uk www.ed.ac.uk/english-language-teaching