Your details Title * - Select -MrMrsMsMiss Family Name * First Name * Nationality Mother tongue Date of birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Current employment Home address Postcode Email * Telephone Do you have any documented health problems or other conditions, such as dyslexia, that may affect your performance on such an intensive course? Yes No If yes please explain. Have you ever been convicted of a criminal offence ? Yes No If yes please explain Reasons for choosing Saint George International How did you hear about Saint George International? - None -InternetBritish CouncilBTAPersonal RecommendationSGI Representative (please give details)Other (please give details) Please give details Secondary Education School Subjects/Grades at A level Further Education / Training University/College Subjects/Grades Other (Please give details) Work Experience Please give dates and details starting with the most recent position(Including relevant Teaching Experience) Languages Spoken Please indicate your knowledge of other languages (whether at Basic /Fair/Good/Native Speaker Level in each case) Your course First choice of course date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Second choice of course date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Will you require accommodation during the course? Yes No Location Where do you want to study? London Vicenza Delhi How to pay Once accepted on the course, I wish to pay by Credit card Sterling cheque Payment by Bank Transfer to: Starling Bank, PO Box 74352, London EC2P 2QU ACCOUNT NAME: SAINT GEORGE INTERNATIONAL ACCOUNT NO: 92846729 SORT CODE: 60-83-71 IBAN NO: GB13SRLG60837192846729 SWIFT BIC: SRLGGB2L Payment / Refund Policy Once accepted onto a course, after an interview, a non-refundable £100 deposit will reserve a place on the course of your choice. Please note that payment can only be made in Pounds Sterling. The balance of fees are normally due 3 weeks before the start of the course. Please note that in the highly unlikely event of Saint George International cancelling the course, we will refund the full fees to you within 2 weeks of cancellation. Please note that for students who have started their course or who cancel within one week of the start date no refund will be made on tuition or accommodation fees. If cancelling with 1-3 weeks notice 50% of the course and accommodation fees will be refunded. Transfer to a later course can be discussed. What code is in the image? * Enter the characters shown in the image.