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Student details

Personal Details

Title *

Name *

First

Last

Family Name *

Email *

Date / Time *

Country of birth *

City of Birth *

Nationality *

(as listed on your passport)

Passport Number *

Passport Issue Date *

Passport Expiration Date *

Student details

Address (Where you currently live)

Address

City of residence

Postcode

Country

Telephone Number *

(please include full country & area dialing codes)

Mobile

Discount/Promotional Code

Have you used an educational agent? / Are you an educational agent *

Where should we send your invoice? *

Country *

How did you hear about us? *

Are there any medical or health conditions we should be aware of? *

If you have answered ‘yes’ to the above question Stafford House will send you a separate document Medical Information Disclosure Form to complete. We are required to obtain consent to process medical information. If the student is under 18 we will ask for parental consent to process this information and this form must be completed before arrival. Please note that Stafford House reserve the right to make changes to a student’s course and accommodation if this form is not returned or something is later discovered upon arrival at the school.

Any Other Comments

Student details

Student details

Email & Phone

Our Address