Auditoria Interna

NOT FOR SALE

Application form
Please return to: (Centre stamp)
please attach a recent passport-sized photograph here securely (Note: the photograph must not be more than 6 months old) please attach a second identical signed passport-sized photograph here using a paper clip

PLEASE WRITE IN BLOCK CAPITALS 1 Preferred date of test 2 Last (family/surname) name 3 Title (Dr/Mr/Mrs/Miss/Ms) 4First (given) name(s) (These names must be the same as the names on your passport/National Identity Card and must appear in the same order.) 5 Address: Please note you will only be sent one copy of your results. Please ensure the correct mailing address is given, since your results will be sent to this address.

d

d m m y

y

second choice

d

d m m y

y

6 Telephone/Mobile number 7Email

8 Date of birth

d

d m m y

y

9 Gender

F

M

(circle as appropriate)

10 Please indicate which document you will be using as proof of identity and give the number below. Candidates taking the test outside their own country must present a current passport. You must bring the ID document indicated below to the test. This is the only form of identity that will be acceptedon the test day. The document must be valid/not expired at registration and on the test day. Passport Passport or National Identity Card number National Identity Card

For office use only
scheme date of payment ID checked AC GT
Please turn over

test date

d

d m m y

y

d

d m m y

y

receipt number Administrator’s initials

1

For questions 11–14 please enter codes andthe name of the country and first language. Codes can be found on pages ii–iv. Please take care and enter this information accurately. If the codes you enter here are incorrect, the information on your Test Report Form will also be incorrect. 11 Country or region of origin (code) Country or region of origin (name) 12

12 First language (code) First language (name)

13 13 Occupation (sector)Occupation (level)

if other, please specify if other, please specify

14 Why are you taking the test?

if other, please specify

15 15 Which country are you applying to/intending to go to? Australia Canada New Zealand

(tick one box only)

Republic of Ireland

United Kingdom

United States of America

other, please specify

16 16 Which IELTS test module are you taking?

(tickone box only)

Academic

General Training

Please note that it is the candidate’s responsibility to select the test module that best meets their needs. The General Training module is not available on every test date.

17 Have you taken IELTS (either Academic or General Training) before?

yes
(go to question 18)

no
(go to question 19)

18 19 Most recent IELTS test details: Centrename Centre number date

d

d m m y

y

19 20 Where are you currently studying English (if applicable)?

20 21 What level of education have you completed? secondary up to 16 years

(tick one box only)

secondary 16–19 years

degree or equivalent

post-graduate

21 22 How many years have you been studying English? 1 (less than) 2 3 4 5

(tick one box only)

6

7

8

9or more

22 23 Do you have any special requirements due to ill health/medical conditions? yes

no

If yes, please specify your requirements below. You must attach supporting medical evidence to this form. Requests for modified test materials must be submitted at least 3 months before the test.

2

Notice to Candidates
IELTS test terms and conditions
You must …
• provide proof of youridentity (passport or national identity card) at registration. This identity document must contain a number, a signature, a date of birth and a photograph. You should contact your test centre who will tell you which type of identity document they accept. Candidates taking the test outside their own country must produce a passport. • provide two recent identical passport-sized photographs on...