Delta Modules course – Application Form

First name Click or tap here to Surname Click or tap here to enter text.
enter text.
Course (M1, M2, M3 Click or tap here to Starting on Click or tap here to enter text.
or a combination) enter text.

Personal information & background

Date of birth Click or tap here to enter text.

Nationality Click or tap here to enter text.

First language Click or tap here to enter text.

Other languages (CEFR) Click or tap here to enter text.

Education Click or tap here to enter text.

Secondary & Higher

Qualification / training Click or tap here to enter text.

(include details)

Experience post- Click or tap here to enter text.

certificate
(include length and
context)

Experience (overall) Click or tap here to enter text.

Contact details
Email Click or tap here to enter text.

Skype ID Click or tap here to enter text.

Telephone Click or tap here to enter text.

Address Click or tap here to enter text.

(incl. post code)

Emergency contact Click or tap here to enter text.

number and email

Are you aware of any pre-existing condition which could affect your performance Yes ☐ No ☐
on the course or your ability to complete the course? If so, please provide details.

Click or tap here to enter text.

Is there any other information the centre should be aware of? If so, please provide Yes ☐ No ☐
details.
Click or tap here to enter text.

Reference (name, position, contact info) Click or tap here to enter text.

Why did you choose IH Bangkok/Chiang Click or tap here to enter text.
Mai?

IH Bangkok & IH Chiang Mai – Application task for Delta Modules course
Conditions of Application
Acceptance onto the Cambridge Delta Modules course at IH Bangkok and Chiang Mai is not guaranteed and
is subject to successful completion of the application form, pre-interview task and an interview. Previous
qualifications and prior relevant work experience will not guarantee acceptance onto the course.
Candidates must also demonstrate that their level of English, both spoken and written, is suitable for the
demands of the course, i.e. CEFR level C1.

By submitting this application, you confirm that you are of sound health and are aware of no conditions
which can impede your participation on the course.

Please note that severe penalties are applied if plagiarized work is detected. These will range from loss of
marks to disqualification and a ban on re-entry for a period of up to three years.

Acceptance on a course does not mean a place has been reserved for you. A place cannot be reserved until
a deposit has been paid. The balance of the full fee must be paid no later than one month before the start
of the course. Deposits and fees are not transferable.

Acceptance on a course does not guarantee passing the course.

The course itself is very intensive. By submitting this application, you accept that in addition to the contact
hours during the course, you will have to work in your own time during the course (lesson preparation,
reading, observations etc.).

100% attendance is expected. Any exceptions need to be approved by the Main Course Tutor.

No refunds will be given should you withdraw from the course for any reason.

Certificates are issued by the Cambridge Assessment English and are forwarded to the centre in due
course.

The course will run as long as there are sufficient participants. Course dates may be changed at the
discretion of the centre.

I have read and understood the conditions of the application.

Signature __________________________________ Date Click or tap to enter a date.

For more information, please contact:

International House Bangkok / Chiang Mai

9th Floor, The Trendy Office Building,

Sukhumvit Soi 13, Khlongtoey-Nua,
Wattana, Bangkok, 10110, Thailand
Tel: +66 (0)2 168 7641
delta@ihbangkok.com or delta@ihchiangmai.com

IH Bangkok & IH Chiang Mai – Application task for Delta Modules course