a2.jpg ENGLISH Foundation Courses Leicester International Pathway College (LIPC), Leicester STUDENT DETAILS NAME * SURNAME * DATE OF BIRTH * Day12345678910111213141516171819202122232425262728293031 Day MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Year19511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Year NATIONALITY * HOME ADDRESS * P.C. * CITY * HOME PHONE NUMBER * MOBILE NUMBER * E-MAIL * LANGUAGE LEVEL * N/AA1A2B1B2C1C2 ENGLISH * ENGLISH - N/A ENGLISH - A1 ENGLISH - A2 ENGLISH - B1 ENGLISH - B2 ENGLISH - C1 ENGLISH - C2 FRENCH * FRENCH - N/A FRENCH - A1 FRENCH - A2 FRENCH - B1 FRENCH - B2 FRENCH - C1 FRENCH - C2 GERMAN * GERMAN - N/A GERMAN - A1 GERMAN - A2 GERMAN - B1 GERMAN - B2 GERMAN - C1 GERMAN - C2 ITALIAN * ITALIAN - N/A ITALIAN - A1 ITALIAN - A2 ITALIAN - B1 ITALIAN - B2 ITALIAN - C1 ITALIAN - C2 SPANISH * SPANISH - N/A SPANISH - A1 SPANISH - A2 SPANISH - B1 SPANISH - B2 SPANISH - C1 SPANISH - C2 HAVE YOU EVER TAKEN PART IN AN EDUCATIONAL TOUR BEFORE? * YES NO HOBBIES YES VOLLEYBALL VOLLEYBALL - YES SWIMMING SWIMMING - YES BASKETBALL BASKETBALL - YES CINEMA/THEATRE CINEMA/THEATRE - YES DANCING DANCING - YES FOOTBALL FOOTBALL - YES MUSIC MUSIC - YES TENNIS TENNIS - YES Please state any health issues/allergies or special diet you follow or provide official medical guidelines No health issues Some health issues, no need to provide details Some health issues, I will provide details later COMMENTS PARENT / LEGAL GUARDIAN DETAILS NAME SURNAME HOME ADDRESS HOME PHONE NUMBER MOBILE NUMBER PROFESSION TAX IDENTIFICATION NUMBER (TIN) (for invoicing purposes) TAX OFFICE (for invoicing purposes) E-MAIL I ACCEPT THE TERMS AND CONDITIONS I have read & agree to the Terms & Conditions. * Read the terms and conditions here ΑΠΟΣΤΟΛΗ
