University of Sheffield English Language Teaching Centre

Expression of Interest Form

Certificate in English Language Teaching to Adults (CELTA)

Please complete this form on computer and return it by e-mail to

PERSONAL DETAILS – details & spelling must be the same as shown in your passport

Family name (surname) / Nationality
First name(s) / Country of birth
Other names / Passport No
Sex (m/f) / Email address
Date of birth / Telephone No
Permanent address / Contact address (if different)
Address line 1 / Address line 1
Address line 2 / Address line 2
Address line 3 / Address line 3
Town/city / Town/city
Region / Region
Country / Country
Post code / Post code
Do you have any disability or special needs you wish to tell us about? qYes qNo
If yes, give details (or enclose a separate sheet.)

QUALIFICATIONS- Please give details of your academic, professional and/or vocational qualifications.

General Education: -

Teaching Qualifications:-

English:-

TEACHING EXPERIENCE

Please give details of any teaching experience, including subjects, age range, institutions and specialisms:

INTERNATIONAL EXPERIENCE

Please give details of any experiences of living, working, studying or travelling to other countries.

University of Sheffield English Language Teaching Centre

Expression of Interest Form

COURSE (Please indicate which course you would like to take)

CELTA and CELTA Course Online
q Wednesday 10th October, 2012 to Thursday 14th March 2013 (Wednesday & Thursday evenings, 5:00pm to 8:00pm)
q Tuesday 14th January 2013 to Friday 24th May 2013 (5-8pm Tues, with a 3-week break from March 18th to April 8th ) – NOTE; This course is a CELTA Course Online
q Monday 1st July 2013 to Friday 26th July 2013 (All day Monday to Friday)
q Monday 29th July 2013 to Friday 23rd August 2013 (All day Monday to Friday)
Accommodation: q Halls of Residence (Self-catered en suite)
July/August Only q None required

COURSE FUNDING

Please indicate how you will be funding the course.

q Self

q Institution

q Other (Please give details)______

Declaration: I

I understand that this form is an expression of interest only and that I must complete the full application process, including interview, before being offered a place on a CELTA course or a CELTA Course Online. .

Please complete this form on computer and return it by e-mail to

ELTC,

78 Hoyle Street,

Sheffield, S3 7LG, UK

Telephone: ++44 114 222 1780

Fax: ++44 114 222 1788

e-mail: