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Full Name of Student

Date of Birth

Nationality

Home Address

Telephone

Name of Parent (or guardians)

Profession of Parents (or guardians)

If the parents (or guardians) reside overseas give the full name address and telephone number of a responsible adult in the United Kingdom to whom application may be made in case of any emergency

Previous schools (with dates)

How did you hear about Brooke House College?

Course Applied For

Advanced Level TWO YEAR COURSE for entry to university

Advanced Level JANUARY START/18month COURSE for entry to university

Foundation Course ONE YEAR COURSE for mature students leading to university

GCSE ONE YEAR PREPARATORY COURSE leading to either the Foundation Course or A Level Course

What is your intended start date for your course?

What is your intended career/ course of university study?

For Overseas students:

EFL: English as a Foreign Language is a compulsory component of all Brooke House courses for students whose English is not of the required standard for U.K. university entrance.

How long have you been learning English?

years

What was your most recent TOEFL/IELTS/#1119/GCE O Level result?

How would you describe your level of fluency in English?

Fluent Good Fair Weak

Previous Examination Results

DATE	TITLE OF EXAMINATION	SUBJECT	RESULT