TSA Course: : 27th and 28th June 2020

Student Information

First Name*

Last Name*

Preferred name*

Date of birth*

Nationality*

Gender*

E-mail*

Home telephone number*

Mobile number*

Address*

Fees

Payment Terms

Please note that a place on the course will only be reserved if the form is fully completed and payment is received by Monday 22nd June 2020. Payments should be made by bank transfer directly to:

Payment reference: TSA {plus first three letters of your surname}
Account name: Greene’s Education Limited
Bank: Lloyds Bank
Sort code: 30-96-35
Account number: 68035968
IBAN: GB58 LOYD 3096 3568 0359 68
BIC: LOYDGB21023

Who is paying for the course?*

I am
Parent / guardian
Another person

Parent or guardian information

First Name*

Last Name*

Title*

Relationship to the student*

E-mail*

Home telephone number*

Mobile number*

Address*

Other person information

Please could you give us details of this additional person

First Name*

Last Name*

Title*

Home telephone number*

Mobile number*

E-mail*

Address*

Academic information

Please provide us with the information below so that we can best tailor our course to you. Please write "n/a" in a required field which is not applicable.

Current school*

GCSE or IGCSE grade in Mathematics & English Language?*

Are you taking the TSA section 2 "Writing Task"?*

Yes
No

Declaration

*

I/we declare that the information on this form has been provided in good faith and to the best of my/our knowledge is true; and that I/we understand the payment terms above.

I/we also understand that the information that has been provided will be treated confidentially.

Accepted