Sangre de campeon invensible

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 2 3 4 Preferred date of test Family name Title (Dr/Mr/Mrs/Miss/Ms) Other 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 7

Telephone/Mobile number email

8

Dateof 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 or National Identity Card. You must bring the ID document indicated below to the test. This is the only form of identity that will beaccepted on 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 entercodes and the 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)

12 12 First language (code) First language (name)

Country or region of origin (name)

13 13Occupation (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/intending to go to? Australia Canada

(tick one box only)

New Zealand other, please specify

Republic of Ireland

United Kingdom

United States of America

16 16 Which IELTS test format are youtaking?

(tick one box only)

Academic

General Training

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

17 Which IELTS test are you taking?
(tick one box only)

pen and paper test

computerised test (CB IELTS)
(please check availability with the centre you areapplying to)

If you are taking CB IELTS are you taking the Writing Test on paper?

(tick one box only)

yes

no

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

yes
(go to question 19)

no
(go to question 20)

19 Most recent IELTS test details:

Centre name Centre number date

d d m m

y

y

20 Where are you currently studying English (ifapplicable)?

21 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

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

(tick one box only)

5

6

7

8

9 or more

23 Do you have any special needs 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 must be submitted at least 3 months before the test.

2

Notice to IELTS Candidates
Disqualification warning Rules and Regulations
You must… • Provide proof of your identity (e.g. passport or national identity card) at registration and every examination session. Second country...