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Personal Data

First Name *

Family Name *

Mailing Address

Apartment/Suite Number

City

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Country

Phone (include country code)

Fax (include country code)

E-mail Address *

Date of Birth *

(mm/dd/yyyy)

Your Gender *

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Are you a Native English Speaker? *

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Passports held for which countries? *

Name and Phone of Emergency Contact *

Education and Work Experience

Your Education *

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College graduate
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Focus of Studies

Degree(s) Granted

Name of College(s)

Professional Work Experience
and Dates/Length of Service

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and Dates/Length of Service

Current Profession

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Accommodation Details

Will you require accommodation?*

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Please indicate whether you smoke? *

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Please describe any special requirements, medical conditions or dietary restrictions

Accommodation

~ Choose an option

Option 1 - Tuition Only - US$1,490.00 (excluding accommodation

Option 2 - Tuition Plus Dorm - at Aspire International Villa (excludes meals and Laundry) US$1,690.00

Option 3 - Tuition Plus Single Room - at Aspire International Villa (excludes meals and laundry) US $1,890.00

Option 4 - Tuition Plus Full-Services Twin-share at Aspire International Villa with Breakfast and Dinner Mon-Fri, 3 meals Sat-Sun, laundry Services included US$2,190.00

Option 5 - Tuition Plus Full-Services Single Room at Aspire International Villa with Breakfast and Dinner Mon-Fri, 3 meals Sat-Sun, laundry US$2,390.00

Course Details

First Choice of Location *

First Choice Preferred
Course Dates *

Second Choice of Location

Second choice Preferred Course Dates (Select location first)

Please briefly explain why you wish to take a PELT course and your employment plans after you complete the course*

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Additional Comments

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I have read and agree with the Terms & Conditions

Learning English the
Cultural Way
Gail A. Mitchell
New $13.60!

(Prices MayChange)
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PELT Application Form All questions marked with an asterisk (*) are required!

PELT Application Form
All questions marked with an asterisk (*) are required!