APPLICATION FORM
01, LEVEL 02, REALTY PLAZA, COLOMBO ROAD, JA ELA, SRI LANKA
T.P: 011 213 2348 | 011 224 4495
PLEASE FILL IN BLOCK CAPITALS PR Number: P R
Title : Rev. | Dr. | Mr. | Mrs. | Miss. | Ms. | Mas.
Name with initial(s)
Full name:
Address:
R Date of birth: D D M M Y Y
Telephone:
M Sex: M F (Circle the appropriate)
O NIC or PP:
E – mail:
School name:
What level of education have you completed? (Tick one box only)
Secondary up to 16 years Secondary 16 - 19 years Diploma Degree or equivalent
Post-graduate Other (s)
How did you know about Headway English classes?
Friends / Relatives Seminar/Presentations News Paper/Magazine Internet
Leaflets / Handouts Hoarding / Banner Other (s)
What is / was your stream of study in your Upper Secondary Level? (Tick one box only)
Science Mathematics Commerce Arts ICT Other
Occupation sector (Tick one box only)
Administrative Services Agriculture, Fishing, Forestry, Mining Arts and Entertainment
Banking and Finance Catering & Leisure Construction Industries
Education Health & Social Service Maintenance & Repair Service
Retail Trade Technical & Scientific Telecommunication & Media
Transport Wholesale Trade Personal Service
Other (s)
Occupational level (Tick one box only)
Self-employed Employer/Partner Employee (Middle or Junior Level) Employee (Senior Level)
Worker in the home Retired Student Other (s)
Name of the department/Organization:
[Turn off]
Why did you choose Headway as your Language Solution Provider? (You can tick () any number of boxes)
cq;ffs; Mq;fpy nkhop Mw;wiy tpUj;jp nra;a Vd; Headwayiaj; njupTnra;jPu;fs;? (nghUj;jkhdtw;iwj; njupT nra;ayhk;)
Standard of teaching jukhd fw;gpj;jy;
Courses are well recognized mq;fPfupf;fg;gl;l fw;if newpfs;
Well recognized certificates and/or Cambridge certificates mq;ff
P upf;fg;gl;l rhd;wpjo;fs; kw;Wk; Cambridge ru;tNjr rhd;wpjo;fs;
Good Headway Experience shared by your friends cq;fs; ez;gDf;F Headwayy; fpilj;j rpwe;jnjhU mDgtj;ij
ePq;fSk; ngw;Wf;nfhs;s Ntz;Lk; vd;gjw;fhf
Resource persons (Teachers) rpwe;j Mrpupau;fs;
The learning environment rpwe;j fy;tpr; #oy;
Student centered teaching methodology khztu;fis ikag;gLj;jpajhd fw;gpj;jy; Kiwik
Other (s) NtW VjhtJ fhuzq;fs; ,Ug;gpd;
I certify that the information on this form is complete, true and accurate
Signature: Date D D M M Y Y
For office use only
Admission number: S T U
Course applied for:
Admission date: D D M M Y Y
Officer’s initials:
Placement Test: B E P I Score:
Interview Comments:
APPLICATION FORM
01, LEVEL 02, REALTY PLAZA, COLOMBO ROAD, JA ELA, SRI LANKA
T.P: 011 213 2348 | 011 224 4495
PLEASE FILL IN BLOCK CAPITALS PR Number: P R
Title : Dr. | Mr. | Mrs. | Miss. | Ms. | Mas.
Name with initial(s)
Full name:
Address:
Date of birth: Sex: F M (Circle the appropriate)
School name:
Parent’s/Guardian’s details:
Telephone: R M
E – mail:
How did you know about Headway English classes?
Friends / Relatives Seminar/Presentations News Paper/Magazine Internet
Leaflets / Handouts
Other (s) Hoarding / Banner
Occupation sector (Tick one box only)
Administrative Services Agriculture, Fishing, Forestry, Mining Arts and Entertainment
Banking and Finance Catering & Leisure Construction Industries
Education Health & Social Service Maintenance & Repair Service
Retail Trade Technical & Scientific Telecommunication & Media
Transport Wholesale Trade Personal Service
Other (s)
Occupational level (Tick one box only)
Self-employed Employer/Partner Employee (Middle or Junior Level) Employee (Senior Level)
Worker in the home Retired Student Other (s)
Name of the department/Organization:
Why did you choose Headway as your Language Solution Provider? (You can tic () any number of boxes)
cq;ffs; Mq;fpy nkhop Mw;wiy tpUj;jp nra;a Vd; Headwayiaj; njupTnra;jPu;fs;? (nghUj;jkhdtw;iwj; njupT nra;ayhk;)
Standard of teaching jukhd fw;gpj;jy;
Courses are well recognized mq;fPfupf;fg;gl;l fw;if newpfs;
Well recognized certificates and/or Cambridge certificates mq;ff
P upf;fg;gl;l rhd;wpjo;fs; kw;Wk; Cambridge ru;tNjr rhd;wpjo;fs;
Good Headway Experience shared by your friends cq;fs; ez;gDf;F Headwayy; fpilj;j rpwe;jnjhU mDgtj;ij
ePq;fSk; ngw;Wf;nfhs;s Ntz;Lk; vd;gjw;fhf
Resource persons (Teachers) rpwe;j Mrpupau;fs;
The learning environment rpwe;j fy;tpr; #oy;
Student centered teaching methodology khztu;fis ikag;gLj;jpajhd fw;gpj;jy; Kiwik
Other (s) NtW VjhtJ fhuzq;fs; ,Ug;gpd;
I certify that the information on this form is complete, true and accurate
Signature: Date D D M M Y Y
For office use only
Admission number: S T U
Course applied for:
Admission date: D D M M Y Y
Officer’s initials:
Placement Test: B E P I LG Score:
Interview Comments: