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Please enable JavaScript in your browser to complete this form.Student DetailsName *FirstLastSex *MaleFemaleDate of birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nationality *Mobile telephone number *Email address *Home address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryThe address provided will be used for any correspondenceAdditional InformationPlease try and give as much detail as possible. This will help us get to know you better and it will also help our teachers to prepare lessons tailored to your ability, hobbies and interests. What are your interests and hobbies? *How long have you been studying English? *Why do you want to improve your English? *Do you have any special educational needs? If yes, what? *What is your current level of English? *Not surePre A1 (Complete Beginner)A1 (Beginner)A2 (Elementary)B1 (Intermediate)B2 (Upper-Intermediate)C1 (Advanced)C2 (Proficiency)Please now take the British Council Online English test and please provide both your percentage and level you achieved, this is shown at the end of the test.British Council Online English Test The test can take up to 20 minutes and there are 25 questions in total. Our teachers will use your results to help prepare lessons tailored to your ability.Parent or Guardian DetailsName *FirstLastRelationship to student *24 hour telephone number *ConsentConsent for the recording and use of images and video *I give consentI do not give consentDuring UK2Learn's online lessons we may wish to take a photograph or video recording parts or all of your lesson either for our own records, for use as part of our learning curriculum or for inclusion in our promotional material such as our brochure, marketing emails and our website. To comply with the Data Protection Act 1998 and the new General Data Protection Regulation (May 2018), we need to ask for your consent before the school or the media record any images of you or your son/daughter. In view of this, please read the statement and select an option below. 1. We may use your/your son or daughter’s photograph in our brochure, marketing emails and other publications we produce for promotional purposes. 2. We may use your/your son or daughter’s image on our website and social media. 3. We may record your/your son or daughter’s image on video. 4. Your/your son or daughter’s image may appear in the media. 5. Your/your son or daughter’s first name may appear with the image in the media. 6. Your/your son or daughter’s image will be stored on our management systems to help staff identify students. You have the right to withdraw consent at any time. Should you wish to withdraw consent, please contact us.AgreementBy clicking submit, both student and parent agree to and understand that the information they have provided is correct and that they are happy for UK2Learn to contact them directly. PhoneSubmit
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