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TEST YOUR ENGLISH
Search for:
Booking Form Erasmus+
admin
2021-11-11T16:44:05+01:00
Booking Form Erasmus+
Your Details
Name
First
Last
Date of Birth
DD slash MM slash YYYY
Gender
Female
Male
Nationality
Please choose country
Afghanistan
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Algeria
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Congo, Republic of the
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Samoa
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Slovenia
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Sudan, South
Suriname
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Sweden
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Uganda
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Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Passport Number
Required for Non-European citizens.
Email
*
Student's Mobile Number
Emergency Contact Number
Course Booking
Course
Choose your Course
Dublin - Erasmus+ General English Language Training
Dublin - Language, Methodology and Culture
Dublin - English for Higher Education Professionals
Dublin - Sustainability and the Environment in Education
Dublin - CLIL
Dublin - Digital Transitions
Malta - Erasmus+ General English Language Training
Start Date (Mondays only)
DD slash MM slash YYYY
Enter course start date
Number of Weeks
Estimated Level of English
Level of English
Elementary (A1)
Pre-Intermediate (A2)
Intermediate (B1)
Upper-Intermediate (B2)
Advanced (C1)
Our classes start at an Elementary level of English.
We do not offer beginner classes
. To check your level of English please complete our
Online Placement Test
.
Professional Experience
School name
Teaching experience( Type of school, years of teaching...)
Arrival Details
(if known - not necessary to provide them at this stage of the booking process)
Arrival Flight Number
Arrival Date
DD slash MM slash YYYY
Arrival Time
Departure Flight Number
Departure Date
DD slash MM slash YYYY
Departure Time
Airport Transfer required?
Yes, arrival (€90 Dublin / €35 Malta)
Yes, arrival and departure (€180 Dublin / €70 Malta)
No
Accommodation
Accommodation required?
Yes
No
Type of Accommodation
Type of Accommodation
Host Family (Single Room, Half-Board)
Atlas Residence (Single Room, Half-Board)
Atlas Residence (Twin Room, Shared, Half-Board)
Brickfield Lane Residence (Single Ensuite Room, Self-Catering)
Brickfield Lane Residence (Twin Room, Shared, Self-Catering)
Check-In Date
DD slash MM slash YYYY
Preferably Saturday or Sunday before Course start date.
Number of Weeks
Special Diet?
Yes
No
€20 Dietary supplement (e.g. gluten free diet)
If yes, please specify in detail:
Do you smoke?
Yes
No
Allergies, Medical Conditions, Special Educational Needs and/or Additional Needs.
Allergies, Medical Conditions and /or Additional Needs:
Yes
No
Please specify any existing allergies, intolerances, medical conditions and / or special educational needs by downloading and completing our
Medical & Special Educational Needs Form.PDF
.
Confirmation
*
I have read and accepted the
Terms and Conditions
.*
*
I have read and accepted the information, guidelines and policies outlined in the
Student Handbook
.*
Stay Connected with Atlas
*
We'd love to send you a selection of exciting content, free study resources, exclusive offers and the latest info from Atlas by email. We'll always treat your personal details with utmost care and will never sell them to other companies. See our privacy policy
here
.
Yes please, I'd like to receive exciting content and offers.
No thanks, I don't want to receive exciting content and offers.
Additional Information
Medical Insurance required?
No
Yes: 3 months (€85)
Yes: 8 months (€140)
Only for Non-European citizens.
Any other comments
How did you hear about us?
*
Search Engine (Google, Bing, Yahoo, Yandex..)
Google Ads
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Friend
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