Language Centre
(English as a Foreign Language)UniversityCollegeCork
2015 Summer School Registration Form
-Applicants must be at least 18 years of age-
First Name(s): ______
Family Name: ______
Contact Address: ______
Nationality: ______Male/Female: ______
Date of Birth: _____/_____/____ E-mail: ______
Telephone: ______Mobile: ______
Level of English
Please indicate what level you think you are below:
Lower Intermediate Intermediate Upper Intermediate Advanced Proficiency
All students will be placement tested on their first day to check which level is best for them.
Start dates (please circle one start date)
June / Monday 22 June / Monday 29 June
July / Monday 6 July / Monday 13 July / Monday 20 July / Monday 27 July
August / Tuesday 4 August
(Monday is a bank holiday) / Monday 10 August / Monday 17 August / Monday 25 August
Number of weeks in total
Finish date
Note: Minimum stay 2 weeks, maximum, 10 weeks
Summer School will finish on Friday 28th August 2015
COURSE OPTION / Number of hours / Please Tick √ the course of your choice
Option A
General English / 20 hours per week
Option B
General English + Business / 26 hours per week
Option C
General English + One to One / 26 hours per week
Option D
Cambridge First Certificate Preparation Course including Exam
(4 weeks) / 20 hours per week
Option E
Cambridge Advanced Preparation Course including Exam
(4 weeks) / 20 hours per week
Option F
IELTS Preparation Course / 20 hours per week
Accommodation Options / Please tick your accommodation option / Arrival date / Departure date
Host Family – half-board basis
(Bed / Breakfast and Evening Meal)
Self-Catering Apartments
University Campus Accommodation
(University Hall and Victoria Lodge)
Self-Catering Apartments
Privately owned apartments with free gym and swimming pool on the premises
Note : weekly prices assume arrival Sunday and departure Saturday
Students are liable for payment for any additional nights
If University Hall is not available at date of receiving your booking, we The Language Centre, reserves the right to offer a suitable alternative
Registration Checklist(please √ boxes)1. Fully completed Application Form (sent by post or email) to
2. One passport size photograph with name and date of birth written on the back (sent by post).
3. A non-refundable deposit of €250.00 is payable at enrolment.
Deposits can be paid by bank transfer or by credit/debit card.
(If paying by bank transfer, a copy of the bank transfer should be attached to this form.)
4. Completed Application Forms should be returned, with a copy of bank transfer to:
The Language Centre, O’Rahilly Building, University College Cork, Cork, Ireland.
Please mark your envelope “Summer School”.
Or you can also email your completed form with a copy of bank transfer to:
(For security reasons, please do not send credit card details by email.
credit card details should only be sent by post or given by telephone!)
5. When we receive your application form, we will send you an Acceptance Letter by email.
Please note that balance of fees must be paid four weeks in advance of course start date.
Payment Details
If paying by Bank Transfer:
A copy of the bank transfer for €250.00 should be attached to this form.
Bank Details:
Bank Name: Bank of Ireland,
Address: Bank of Ireland, 32 South Mall, Cork, Ireland
Account Name: UCC Language Centre
Account Number: 87099989
Sort Code: 90-27-68
IBAN Number: IE58 BOFI 9027 6887 0999 89
Bank Identifier Code: BOFIIE2D All bank charges to be paid by student.
(When filling the bank transfer form, please write in “Sum” followed by your name
in the reference section of the form to help us locate the transfer more easily on our statements).
Refunds will only be issued if minimum numbers are not met to form a class (full refund) or if a student withdraws on medical grounds, on production of a Medical Certificate (partial refund). If an original medical cert is produced before the course start date a refund will be issued less the deposit and an admin. fee. If a student withdraws after the commencement of his/her course, a refund will issue less the deposit, fees for portion of course taken and an admin fee. Refunds will not be considered on any other grounds.
For Office Use Only
Date Application Received: _____ /_____/______Date Acknowledgement Sent: ____/____/_____
Deposit paid: €______Method: B/T / Cash / Cheque/Credit card Receipt Number: ______
Bank Transfer confirmed by: ______Amount: ______
Balance paid: €______Method: B/T / Cash / Cheque/ Credit card Receipt Number: ______
Bank Transfer confirmed by: ______Amount: ______
Course Fee: €______
Accommodation Fee: €______or 20 plus 6 hours Business Eng.or 20 plus 6 hours One-to-One
TOTAL Fees: €______or 20 plus ___hrs One-to-One]
Amount outstanding: €______Date Paid: ____/____/____ (e.g. outstanding bank charges or extra nights)
Information
Where did you hear or read about our Summer School? ……………………………………………………………………
Please give details, if possible e.g. name of magazine, social media route, agent etc. :
…………………………………………………………………………………………………………………………………………………………….
Do you have any medical conditions that you feel course coordinators should be aware of:
Yes ______No ______
If yes, please give details:
…………………………………………………………………………………………………………………………………………………………….
We are registered members of:
ACELS (QQI), MEI, AULC, CercleS, IELTS, Cambridge ESOL