ALEXANDER

LANGUAGE SERVICES

27 Aetorahis St., Thessaloniki Greece

Fax: +30-2310-819424

Email: info@als-alexander.org 

                

 

                                                     Attach recent

                                            passport size photo

 

 

 

 

 

 Complete in BLOCK CAPITALS

 

STUDENT APPLICATION FORM    

To be printed, completed and faxed or posted to the above address

FIRST NAME:

LAST NAME:

Mr, Mrs, Ms, Dr. ____

Male (M) Female (F) ____

Marital Status (Married, Unmarried, etc):

Home/Correspondence Address (Street, No):

Date of Birth (dd, mth, yr):                     
Age:

State/Province:

City:

Country:

Nationality:

Phones:

Fax:                                 Email:

Profession/ Occupation (Student, Teacher, Businessman, Freelance, Other please specify):

 

Whom should we contact in case of emergency? (Address, Phones, E-mail):

1.

 

2.

 

Native language:

Second language:

State level (of second lang.):

Country to Study in:

I . D. or Passport No:

Issued by (Authority):

Language(s) to study:

 

Period to study (From - To):

 

 

Social Security #:

Do you hold a current driver’s licence?:

Driver's Licence Number:

 

 

ENGLISH STUDIES

 

School or Institution

Address

From

To

Certificates/Degrees Awarded

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER LANGUAGES 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER STUDIES

 

 

 

 

 

 

 

 

 

 

 

         

 

 

 

 

 

 

 

 

 

 

 

 

What do you want to study this language for?:

 

 

How did you hear about us? (Internet, Magazine etc):

 

 

Why did you choose us?:

 

 

Medical Condition (Do you suffer from any condition we should know?):  

 

 

 

This space is provided for additional  information  about you:

 

 

 

 

 

 

Date ____________200                         Signature ________________________

 

PRINT, COMPLETE AND SEND IT  BY FAX OR POST

____________________

 

PRIVACY POLICY: Your personal  information is kept in strict confidentiality

and is not sold or  shared with  third parties 

 

   Print Application Form