Student Enquiry Form (ETO)

Student Enquiry Form (ETO)
Agency Details
Agency name
Agency contact name
Contact email address
The email address you would like us to contact you on.
Bucksmore Contact
The member of the Bucksmore commercial team who manages your agency account.

Student Details
Number of students for course
Please note: for 2:1 courses where two students will be taught by the same teacher, please complete and submit this Jotform for both students separately.
First Name
Last Name
Gender
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearThis is required for insurance purposes
Nationality
First Language
Passport / ID number
English Level (CEFR)
Has this student taken a Bucksmore course before?
Does the student have any medical requirements that Bucksmore should be aware of?
If yes, please provide more medical information

Please include details of any medical information which the Bucksmore team needs to know. 0/255
Does the student have any learning or behavioural requirements or disabilities which Bucksmore should be aware of?
If yes, please provide more information on their learning & behavioural background or any disabilities

Please include details of any learning or behavioural information which the Bucksmore team needs to know. 0/255
Please list any allergies the student may have
Hobbies and Interests
Additional Student Details
If more than one student is taking the course. Please include their details here.

Course details
Arrival Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearOur courses usually begin on Sundays
Departure Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearOur courses usually end on Saturdays
My dates are flexible
If the student dates are flexible, at what time of year would they like to study?
Number of Tuition Hours (per week)
Course type
Please note: for 2:1 courses where two students will be taught by the same teacher, please complete and submit this Jotform for both students separately.
Which exam is the student preparing to take?
If your student is planning to take an exam in the UK, it is your responsibility to book the exam after the course has been confirmed and ensure that their exam is available during the course dates.
Transfers required?
Additional Information or Requests
If you are unsure about any of the above, please provide more detail here.

Agency Details