Name

Permanent Address

Email Address *

Parent's/Guardian's Name

Parent's/Guardian's Home Phone No.

Parent's/Guardian's Mobile Phone No.*

Correspondence Address *

Student's Home Phone No. *

Student's Mobile Phone No.*

Gender

Date of birth *

Age *

Marital Status *

Nationality *

Passport No. *

Passport Expiry Date *

High School *

College/University

Course Taken

Others

Main Language Spoken *

English Qualification *

Intake

Name

Relationship

Contact No.

Do you have any medical conditions? *

YesNo

Do you require accommodation?

YesNo

Photos

Payment Evident

Passport Copy

I confirm that all the above information are true and I have read and agreed to the Declaration and Agreement of SLC Language Centre