SECTION
1. PERSONAL DETAILS
Now that you have
decided which course meets your requirements, registration is easy
but must be done as soon as possible. The request has to arrive at
least 4 weeks in advance to give enough
time to organize the accommodation.
The teachers and all the
staff are anxious to welcome you to the school in New York
COME AND BREAKDOWN THE LANGUAGE BARRIER IN NEW
YORK!
INSTRUCTIONS
Print out the application form, fill it in
and enclose any other
necessary documents for other programs like the Dance/English
Program. The request has to arrive at
least 4 weeks in advance to give enough time to
organize the
accommodation. Please answer all
questions. All fields marked with a
*
are required and must be completed.
To be eligible for a
I-20 Form A-B (F-1) Student Visa you must send with your
application
:A
letter from your bank or a bank
statement certifying that you have
sufficient funds available in your
account (student) or in the account of your
sponsor to cover all your expenses
during your stay
in the United States.
(This letter must be written in English and the
currency in US$.).
This
document can be sent either by
e-mail,
fax or
post.
Once your application has been received you will be give a
reference N° that you will
need to quote on all correspondence, e-mails or when contacting us
by telephone. We will then:
|
Confirm acceptance
on the appropriate program and will send you an invoice for the
total owed |
|
Wait for the
settlement of your bill which can also be done
on-line |
|
Will send you the
I-20 visa form and the official confirmation of the accommodation |
For
your convenience if you prefer, you can send us your application form
securely on-line.
We also accept
cheques
and
bank transfers. |
First Name*
Last Name*
D.o.B.*
Place of birth:
Age:* |
Gender:* |
|
Nationality:* |
|
Home Tel N°
(country
code first)
Work Tel N°
(country
code first)
Mobile Tel N° (country
code first)
Fax N°
(country
code first) |
E-mail |
|
Address:* |
|
|
Next
of kin (if different from above) Address: |
|
Next of
kin Tel N° (country
code first) |
What is your
mother tongue?* |
Beginners:
Chose course starting date: (please tick) |
11th January: |
1st February: |
1st March: |
5th April: |
3rd May: |
7th
June: |
12th July: |
2nd August: |
13th September: |
4th October: |
1st November: |
6th
December: |
All
other levels state starting date: (any Monday) |
How did you find our web site?*
Please quote Ref N° if applicable:
|
Choice of course:*
(please tick) |
Dance/English
Program: |
Intensive
English Business Group: |
Intensive
English Group: |
TOEFL
preparation: |
Intensive English for professionals private: |
Intensive English for professionals combined: |
Intensive English for professionals group: |
Semi Intensive English Group: |
Semi Intensive English Private: |
Parallel with professional combined: |
Practical Experience for young people: |
Practical Experience for Professionals: |
N°
of weeks required:*
|
Choice of elective classes:*
(please state 3 choices) (please tick) |
American Culture: |
Conversation Practice: |
Film, Radio & Tv: |
Discussion on current affairs: |
Essay & Business Writing: |
Intermediate Conversation: |
Speaking in Public: |
Pronunciation & Reduction of accent: |
Is your elective class:*
(please tick)
Combined to a 30 hr intensive English program:
In supplement to a 20 hr English Course:
Registration to only an elective class: |
N°
of weeks required:*
|
Type of accommodation:*
(please tick) |
Host Family:
|
Residence: |
If a residence is required name of residence:
(please tick:
|
Flushing Ymca:
|
Il de Hirsch:
|
Jazz on the Park:
|
Ten-Eyck Troughton:
|
|
Vanderbilt Ymca |
Type of Room:*
(please tick) |
Single Room: |
Double Room: |
Do you: smoke?*
|
Can
you live in a home with animals?* |
Other useful
information: (allergies, particular diet etc) |
Date of arrival:* |
Date of departure:* |
Note:
Accommodation is available only for the duration of the course.
Students can arrive the Sunday before the start of the course and
depart the Saturday after the end of the course. |
Do
you require a transfer from the airport?* |
If
Yes please supply arrival details:
Flight N°: |
Time
of arrival: |
Name of departing
airport: |
Name of airport of
arrival: |
Please note: we need this
information at least 2 weeks prior
to arrival |
To
speed up my application I would like to receive my I-20
form
by special delivery (£34.00): |
SECTION 4. PAYMENT DETAILS |
Pay to: |
Totalnannies.com |
Payment for: |
Agency Fee for language
course and accommodation
abroad |
Amount: |
£99.00 |
Payment for: |
Registration Fee |
Amount: |
£70.00 |
Payment for: |
Deposit for
Accommodation |
Amount: |
£104.00 |
Total due: |
£273.00 |
I wish to pay for the registration fee by (please tick)
Bank Transfer: Cheque:
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Conditions
1) The
agency fee is £99.00 Pounds Sterling. The
fee must be paid on
application.
2) In the event of cancellation or failed departure on your part
the
agency fee under no circumstances will be refunded.
3) If we are unable to fulfill your request the agency fee will be
refunded in full.
4) On application all relevant registration fees and deposits must be paid
depending on the programs chosen. All these registration fees and
deposits are not refundable.
5) The bill must be paid in full before departure.
6) In the event of cancellation before the start of the course, all
fees will be refunded in full. The registration fees and the
deposit
are not refundable. In the event of cancellation once a course has
begun no refund will be given.
7) Whilst every precaution is taken in the introduction of clients,
we cannot be held responsible for events beyond our control.
I declare that I have read and accepted the conditions.
Signed:
Date:
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