Application Form

To apply to Internexus London, complete the following application.

Personal Information

Family name:
First Name:
Middle Name or Initial:
Birth Date:

Sex:



Marital Staus (optional):
Single
Married

Country of Citizenship:
Country of Birth:
Passport Number:

Present Phone:
Home Phone:
Fax:
E-Mail address:

Parents' Guardians' Names (if you are under 18 years old):

Mailing Address: (if you need a student visa, please fill this with your home country address)
Street:
City:
State:
Country:
Postal Code:

Language Level - please check the box which best describes your current level of language:
Pre-Intermediate
Mid-Intermediate
High-Intermediate
Pre-Advanced
Advanced

Accommodation Information

What kind of accommodation do you need?
Student Residence
Homestay
Private Home (Breakfast Only)
I don't need accommodation.

Do you need airport pick-up service?
Yes (if yes do you need Arrival Departure)
No

Course Information

Which course do you want?
Intensive English (27 hours)
Semi-Intensive English (15 hours, am)
Semi-Intensive English (15 hours, pm)
Special Programme (list name):

How many weeks do you wish to attend?

Which date do you wish to start?


Which date do you expect to finish?


Application Procedure

In order to have your application processed, you need to pay a deposit of £150 or £300 for exam courses. Add an extra £250 if you require accommodation.

How did you hear about Internexus?
Friend/Relative
Internet - Which Site?
Study Abroad Fair
Magazine/Newspaper Ad - Which one?
Former Student - Who?
Agent:
Name:
Address:
Telephone:
Fax:
E-Mail:
Other - Explain:

Do you have any other special requests or concerns?

By clicking on the submit button below, you acknowledge and agree to our enrollment rules and policies.