Cambridge DELTA Module 2 Application Form

COURSE DATES:

I would like to attend the following DELTA Module 2 - Blended Learning Modulecourse:

1stJune–2ndSeptember 2015

PERSONAL DETAILS

Title (Mr/Ms/Mrs/Miss/Dr) / Surname:
First Name(s):
Date of Birth: / Place of Birth:
Nationality: / Mother Tongue:
Telephone: / Country code / Home number
Mobile: / Country code / Mobile number
E-mail address:
Present Occupation:
Present address:
Permanent address:
(if different from above)
In case of emergency:
Please give contact details of a person to contact in case of emergency: name, address, mobile phone and e-mail address.

MEDICAL INFORMATION

Do you have / Have you had a medical condition we need to know about (including psychological conditions)? If yes, please specify.

EDUCATION AND QUALIFICATIONS

Please state when and where you studied and give details (name of school/university/college and qualifications gained).

School: / Qualifications: / Dates:
School: / Qualifications: / Dates:
University: / Qualifications: / Dates:
ELT qualifications: / Awarding body / Dates:
Other Relevant Qualifications:
Other Relevant Qualifications:

Knowledge of other languages:

Language: / Level of Proficiency:
(Elementary/Intermediate/Advanced)
Language: / Level of Proficiency:
(Elementary/Intermediate/Advanced)
Language: / Level of Proficiency:
(Elementary/Intermediate/Advanced)

WORK EXPERIENCE (write in chronological order with most recent first)

Employer / Position / From / To

PLEASE FILL IN THE FOLLOWING SECTION ONLY IF YOU ARE BASED IN SOFIA

Name and address of School/Organisation at which you hope to work during the course
Telephone: / Fax:
E-mail address:
  • Is your school able to provide classes with an average of 5 to 10 adult students at significantly different levels throughout the period of the course?
  • How many hours teaching per week do you expect to have during the period of the programme?

ELT Experience

Please give details of your English Language Teaching experience. Indicate countries, schools, dates, age ranges, levels and materials you are familiar with. An extra sheet with this information may be attached to the application form.

Country / School / Dates / Age range / Level / Materials
OTHER RELEVANT EXPERIENCE
  • How did you find out about the DELTA courses at AVO-Bell Language & Examination Centre?

(website, Internet search engine, word of mouth - please give as many details as possible)

  • Are you applying to centres other than AVO-Bell?
  • Any other information which you think is relevant to this application?
REFEREES

Please give the name, address, telephone number and email address of tworeferees who would be prepared to give relevant support to this application.

PRE-INTERVIEW TASK

Please outline some of the general principles that lie behind your teaching and examples of how you apply them in the classroom. Please include examples from different levels and types of classes. The recommended length is 650 - 750 words.

ACCOMMODATION

Would you like to take advantage of our Special offer with the accommodation included?

  • YES
  • NO

PLEASE NOTE

  • if you leave before the end of the course your fee is non-refundable
  • 100% attendance is required
  • acceptance onto the course does not guarantee success: we screen applicants carefully, but inevitably some candidates fail
  • it is highly recommendable that you have prepared to do or you have already done DELTA Module 1.

TERMS OF PAYMENT

PLEASE DO NOT PAY ANYTHING UNTIL YOU HAVE BEEN INTERVIEWED, ACCEPTED AND OFFERED A PLACE ON A COURSE.

  • Applicants who successfully complete the interview stage of the application process will be offered a place on our DELTA course.
  • Once a place has been offered, it can only be confirmed when a non-refundable deposit of 300 GBP has been paid within 3 days of the interview.
  • If the candidate is paying via bank transfer an amount of 20 GBP should be transferred to cover the candidate’s bank charges.
  • The deposit is not an additional fee and is deducted from the total costs.
  • The balance of the full DELTA course fee must be paid up to 2 weeks before the course start date.

I will pay the non-refundable deposit (please mark the appropriate):

  • by bank transfer
  • by cheque
  • in cash
CANCELLATION OF YOUR APPLICATION
  • Notice of cancellation must be made in writing.
  • If written notice of withdrawal is given 4 weeks or more prior to the start of the course, we will retain only the non-refundable deposit.
  • If written notice of withdrawal is given between 2 and 4 weeks prior to the start of the course, 50% of the fees will be returned to the applicant.
  • If written notice of withdrawal is given less than 2 weeks prior to the start of the course, no refund of fees is made.
  • All refunds will be made in the currency you have paid. Any bank or other charges payable will be deducted from the money refunded to you.

DECLARATION

I hereby declare that all the information I have given on this form is correct to the best of my knowledge and that any written work submitted is my own.

I have read and accepted the above conditions.

Name______

Signed ______Date:

Please keep a copy of this form once you have filled it in.