Enrollment Form

Student Name *

Father's Name *

Date Of Birth *

Student No : A- *

Age : *

Gender *

Female

Male

Education Background *

Contact Address *

Contact Phone *

E-mail Address *

Communicative English *

Pre-College Program *

Basic

Part 1A

Part 2A

Part 2B

Exam Preparation Course *

TOFEL / IELTS (Foundation)

IELTS (Preparation)

Listening/Speaking *

Listening/Speaking 1

Listening/Speaking 2

Grammar *

Grammar (Basic) + Speaking

Grammar (Higher)+ Speaking

Writing *

Writing (Basic)

Writing (Academic)

How did you know about this centre? (Information Sources) *

If others (Please describe) *

	http://www.niecinternational.com.
	01 3550727/ 01 3550728