APPLICATION FORM – SRI LANKA TEACHING

(Pricing in Pounds Sterling, US Dollars and Euros)

 

Please tick where applicable : 

 

FINANCIAL DETAILS

 

Total

1 Month

 GBP 390  (USD 650;   EUR 450)

 

6 Weeks

2 Months

 GBP 490 (USD 800;  EUR 560)

  GBP 590  (USD 950;  EUR 680)

 

3 Months

 GBP 690   (USD 1150; EUR  790)

 

 

 

Deposit:  

 GBP 50 (USD 80;EUR 60)

 

 

 

 

Balance:  

1 Month

GBP 340 (USD 530;   EUR 390)

 

6 Weeks

2 Months

GBP 440 (USD 720; EUR 500)

GBP 540 (USD 870;   EUR 620)

 

3 Months

GBP 640 (USD 1070;  EUR 730)

     

    

TRAVEL DETAILS

Preferred start date……………………………Preferred return date……………………….

PERSONAL DETAILS

MALE/FEMALE – delete as applicable

SURNAME…………………………………………………………………………………………………………….

FORENAMES……………………………………………………………………………………………………….

ADDRESS (HOME)…………………………………………………………………………………………… .
………………………………………………………………………………………………………………………………..

TELEPHONE……………………………….MOBILE……………………………………………………………

ADDRESS (TERM)………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………..

TELEPHONE ………………………………EMAIL……………………………………………………………

NATIONALITY ……………………… DATE OF BIRTH ………………………………………


CURRENT EDUCATIONAL STATUS 

Undergraduate – your degree subject?………………………………………………………………

Graduate – which subject?……………………………………………………………………………………..

Postgraduate – which subject?……………………………………………………………………………..

Other…………………………………………………………………………………………………………………………


NAME OF AN ACADEMIC REFEREE……………………………………………………………………

Address……………………………………………………………………………………………………………………..……

Tel. No…………………………... ………………….Email…………………………………………………………..

GENERAL   Where did you hear about us?..................................

Any allergies or disabilities?………………………………………………………………………………..

Any dietary preferences?………………………………………………………………………………………

Your hobbies/interests………………………………………………………………………………………….

Teaching subjects offered other than English…………………………………………………..


Please attach a recent photograph

 

FINANCIAL DETAILS

 

Please attach deposit of GBP 50  (USD 80 or EUR 60), cheques payable to S.E.A Whitehead*

 

 

Signature……………………………………………………………………………Date………………………………….

 

 

* Postal address:  S E Angela Whitehead, 24 Les Fougeres, 23000 St Sulpice le Gueretois, France

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