section1–personalinformation(asitappearsinyour.docVIP

Section 1 – Personal Information (as it appears in your passport). Please note that the minimum age at LSI BK, BO and SD is 16; at LSI NY it is 18, except for Young Learner Programs First (given) name(s): Family Name: Date of Birth (Day/Month/Year): Female Male Country of Birth: Country of Citizenship: Occupation: First Language: Other Languages: Email Address: Address (in Home Country): City/Town: State (if applicable): Country: Postal Code: Home Tel: Work Tel: Fax: How did you hear about LSI? LSI Website Agency Recommendation Advertisement LSI Graduate Other: How did you book this course? LSI Website Name of Agency/Other Website: Direct Walk-in Section 2 – Course Information (Please read and sign the Terms Conditions) Language Level: Beginner Elementary Pre-Intermediate Intermediate Upper-Intermediate Advanced LSI Course Centre: Berkeley, CA Boston, MA New York, NY San Diego, CA Course Start Date (Day/Month/Year) : Number of Weeks: Course End Date (Day/Month/Year): General English Courses Examination and ESP or Special Courses Executive Courses International School Year Standard 20 Intensive 30 Intensive 30 + English for Business Intensive 30 + TOEFL Cambridge Examination Courses FCE CPE (SD only) CAE English for Specific Purposes English for Teaching –TKT (NY, SD) Special Programs English Club 50+ Mini-Group English for Business 20 lessons/week 30 lessons/week One-to-One ( lessons/week) 9 Day Compact (BK, BO, SD only) 82 private lessons 92 private lessons Schedule: 20 lessons/week Standard 20 30 lessons/week Intensive 30 Duration: 24 + weeks 36 + weeks Duration: total weeks Plus Courses Plus 5 lessons/wk Plus 10 lessons/wk Section 3 – Accommodation Details - $85 Non-refundable accommodation placement fee on all options (Please read and sign the Terms Conditions) Accommodation required? Yes No If yes, choose one type of accommodation below. If n