ELD2021 - Edge Hill International

International

English Language Development Application Form

First Name *

Family Name *

Date of Birth *

Gender *

Nationality *

Email Address *

Home Address, Line 1 *

Home Address, Line 2 *

City *

Post Code *

Mobile/Cell Phone Number

Please indicate your current level of English Language and any qualifications you may hold

Please provide details of any academic qualifications you hold

Do you have any disabilities or medical conditions? ✱

Yes

Please provide full details

Do you have any criminal convictions? ✱

Yes

Please tick this box to confirm you are a refugee from Afghanistan *

If yes, please provide full details

Ways we can contact you

We would also like to stay in touch with you from time to time about things that we think might interest you including, but not limited to, University news, course information, and student life. If you choose not to tick any boxes, this means that you have opted out of communications from us and you might miss some interesting information in the future.

Email (this is our main method of communication)

Phone

Post

SMS

Edge Hill University will process the data that you provide on this form responsibly and in full accordance with the General Data Protection Regulation.

We respect your privacy and your personal data will not be shared with any third party organisations for marketing purposes.

Read our full Privacy Notice for more information about how we responsibly and securely process your data.

I agree to the processing of the data provided in accordance with Data Protection Legislation*

Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP
+44(0)1695 657122

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edgehill.ac.uk/international

English Language Development Application Form

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