NESE On-Line Private Tutoring Application

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Student Information Sheet

Email *

Title: *

First Name: *

Family Name: *

Birthdate: *

YYYY

Telephone Number: *

Country: *

Profession: *

Representative Information

Agent Name:

Agency Name:

Agent Contact Email:

Date of First Lesson: *

YYYY

Total Number of Hours Requested: *

Number of Weeks Requested: *

Number of Lessons per Week Requested: *

Specific Times Requested: *

Are you studying with a group?

Please provide answers for the following 2 questions IF you are studying with a group.

How many people will be in your group?

Please list the names of the students in your group.

Please note: Each person in your group must also submit an application.

Areas of Interest:

Please check all that apply:

Grammar & Idioms

Conversation & Listening

Reading & Writing

Pronunciation/Accent Reduction

Medical English

Business English

Sports English

Business Writing

TOEFL Preparation

TOEIC

Reading

Listening Comprehension

Presentations

IELTS

Aviation English

Standardized Test Preparation

University & College Counseling

Teacher Training

Classes for Children

Classes for Seniors

Other:

Required

NESE Levels (if applicable):

TOEFL Score (if applicable):

Cambridge First Certificate/Proficiency Grade (if applicable):

Student's Goals (Please, include as much information as possible so that NESE On-Line can help you meet all your goals):

How many years have you been taking English lessons? *

For Students Under the Age of 16:

Why do you want to learn English?

What hobbies do you have?

What is your favorite animal?

What sports do you like?

What is your favorite TV show?

NESE On-Line's Tutoring Cancellation Policy

• Please know that if you cancel your tutoring more than seven days before the start date, there will be no penalty for cancellation.

• If you cancel your tutoring fewer than seven days before the start date, please understand that you will be charged for two hours' worth of tutoring.

• Please know that by completing this form, you are accepting the terms of NESE On-Line's Tutoring Cancellation Policy.

• Please know that all tutoring students are required to take the NESE On-Line placement exam before starting classes.

Payment Information *

I'd like to pay via Credit Card. (Please see instructions below)

I've sent a wire transfer.

I've sent payment via Flywire. (nese.flywire.com)

Payment Information Details *

Please include any payment details below. (Payment transfer number, Paypal account or Flywire payment confirmation number)

Instructions to Pay via Credit Card:

1. Please click the following link to download the Credit Card Authorization Form. https://nese.edu/CC_Auth_Form.pdf

2. Please email the completed Credit Card Authorization Form to "apply@nese.edu".

Student Acknowledgement: *

My signature below confirms I understand and acknowledge the expenses for attending NESE On-Line. I also fully understand the Cancellation Policy for attending NESE On-Line. I agree to be held legally responsible for all costs and any cancellations incurred by the applicant in connection with NESE On-Line. Submission of this application constitutes an acceptance of the terms and conditions of enrollment included in the application package. Please type your name below.

Student Acknowledgement Date: *

YYYY

Signature of Guardian if under 21:

Signature of Guardian Date:

YYYY

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