Student Enquiry Form (Directs)

Student Enquiry Form
Student Details
Lead ID
Course Consultant
Number of students for course
If more than one student will be attending the course, how many? You can provide details for additional students below.
First Name
Last Name*
Email
example@example.com
Phone Number

Area CodePhone Number
Gender*
Date of Birth*

DayMonthYear
This is required for insurance purposes
Nationality*
First Language*
Passport / ID number
English Level (CEFR)
Has the student taken a Home Tuition course before?

YesNo
Does the student have any medical requirements that Bucksmore should be aware of?*

YesNo
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?*

YesNo
If yes, please provide more information on their learning & behavioural background or 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
Our courses usually begin on Sundays
Departure Date

DayMonthYear
Our courses usually end on Saturdays
My dates are flexible

YesNo
If the student dates are flexible, at what time of year would they like to study?
Number of Tuition Hours (per week)
You can find full details of course fees in our brochure (www.bucksmore.com/homelingua2020/).
Course type
You can find full details of course fees in our brochure (www.bucksmore.com/homelingua2020/).
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.
Additional Information or Requests
If you are unsure about any of the above, please provide more detail here.

Student Enquiry Form