Last Name First Name

Home Address

Phone

Mobile

E-Mail

Date of Birth

female male

Nationality

National ID No

single married

Student Application Form

Highest level of Education completed

Graduated yes no

Language Skills (Self Assessment)

Beginner

Passport No

Educational Background

Number of Weeks

Speaking High Beginner Low Intermediate Intermediate High Intermediate Advance

Listening Beginner High Beginner Low Intermediate Intermediate High Intermediate Advance

WritingReading

Beginner

Beginner High Beginner

High Beginner

Low Intermediate

Low Intermediate Intermediate

Intermediate High Intermediate

High Intermediate Advance

Advance

Duration of StudyStart Date End Date

Person to Contact in Case of Emergency

Name Phone

UV ESL Center #901 Doosan Bearstel 1319-11, Seocho-dong, Seocho-gu, Seoul, 137-072, South KoreaTel: 020558-4775, 4776 / Fax: 02)558-4779Homepage: www.uvesl.com E-mail: uvesl@uvesl.com

Curriculum:

1:1+1:1+1:1+ 1:5+1:10+1:10+SC+SC

Comprehensive ESL Course

ESL for EXAMSSpecialized ESL Courses

1:1+1:1+1:1+ 1:5+TOEIC+TOEIC+SC+SC1:1+1:1+1:1 +1:5+TOEFL+TOEFL+SC+SC1:1+1:1+1:1+ 1:5+IELTS+IELTS+SC+SCIELTS

TOEICTOEFL

Accommodation

Single Room Twin Room Triple Room

Flight Details

Cebu Pacific Cathay Pacific Korean Airlines

Other Airlines Flight Number Date

Payment and Refund Rule:

∆ No refund is given for the 8-week term. School fees / school admission are likewise non-transferable. ∆ Registration fee is non-refundable. ∆ No classes are held on legal and national holidays. There is no refund of payments if your period of registration falls on legal and national holidays.

UV ESL Center #901 Doosan Bearstel 1319-11, Seocho-dong, Seocho-gu, Seoul, 137-072, South KoreaTel: 020558-4775, 4776 / Fax: 02)558-4779Homepage: www.uvesl.com E-mail: uvesl@uvesl.com

∆ Full payment should be made prior to the student's arrival in the academy. Please send us a copy of the bank deposit slipfor payment acknowledgment.

∆ Course extension must be paid within a week after application. A refund of 50% can be claimed if you wish to discontinue your extension.

Agency Name Telephone No.

Fax No.

∆ In case of deaths in the immediate family, 100% refund can be claimed on the remaining term. However, a certificate or document from a medical representative should be presented in our Seoul office to verify the truthfulness of the circumstance. (Immediate family is limited to the student's first degree relatives such as the parents, siblings, spouse or child.

∆ Refunds will be given to the agency and not to the students directly. ∆ Term Extension is a FIRST COME and FIRST SERVE basis, depending on the availability. Term extension is computed per weekly basis. Course extension fee must be paid within a week after the application. A refund of 50% can be claimed if you wish to discontinue your extension.

∆ Pick-up fee is free from 6P.M. Friday until 6A.M. Monday. $30 charge for other pick-up days.

Acknowledgement

By affixing signature to this form, the student acknowledges his/her understanding and acceptance to all terms and conditions of this application.

Date, Signature