864  987  0067


TESOL REGISTRATION  APPLICATION
(print out and fill in all sections)
Date:
First and last name:
Street Address:
City/State/Zip Code/Country:
Daytime Phone:
E-mail Address: 
Date of Birth (mm/dd/yyyy):
Male or Female:
Best time to call for an interview:
Course you have selected:
City where course will be held:
PREVIOUS EDUCATION EXPERIENCE   List schools or programs you have attended, beginning with the most recent, the degree or diploma received, and the subjects studied.
School or Program Degree or Diploma Subjects Studied
1. 1. 1.
2. 2. 2.
3. 3. 3.
4. 4. 4.
5. 5

EMPLOYMENT   List your employers, beginning with your most recent position.
Employer Employment Dates Position Held
1. 1. 1.
2. 2. 2.
3. 3. 3.
4. 4. 4.
5. 5. 5.
6. 6. 6

If not listed above, tell us about your previous teaching experience.  If more space is needed, use a separate sheet of paper. Include your name at the top and attach to your application.


 
 
 
 
 
 
 
 
 
 
 
 
 
 



 LIFE EXPERIENCE   List 3 or 4 job or life experiences you believe contributed to your abilities to be a great English as a Second Language teacher.

Experience When? Skills Learned or Improved
1. 1. 1.
2. 2. 2.
3. 3. 3.
4. 4 4

Is English your first language or do you speak English fluently?  (Check one answer below)
_____ Yes      _____ No
If you answered NO to the question above, what was your score on the TOEFL? ___________

If English is not your first language and have not taken the TOEFL, we will arrange a language assessment for you             during the phone interview.

Write 1-2 paragraphs about: 1) why you would like to be part of the TESOL Certification Program or 2)  any interesting       learning experience you have had in your life that demonstrates why you are interested in this program. Use a separate sheet of paper, place your name at the top, and attach it to your application.

ONE  FINAL  NOTE!  After your application has been processed and your payment approved, we will conduct a phone interview with you at the time you specified above. This phone interview will give us a chance to discuss your expectations, tuition payment options and any questions you might have about the course.   



APPLICATION  FEE  PAYMENT

A $100 application fee must be included with your application for it to be processed.

Please mark your preferred payment of the non-refundable $100 application fee below:
____ personal check or money order     ____ MasterCard, Visa, AMEX, or Discover credit card

If paying by check or money order, please make payable to English for Life Academy.

If paying by credit or debit card, please fill out all the information requested below.
    Check which card you are using:
   ____ MasterCard  ____ Visa   ____  American Express  ____ Discover
   ____ credit    ____ debit
  Card Number _____________________________________________________
  Card Expiration Date ________________________________________________
  3-digit Security Code (on back of card following the card number) ____________
  4-digit Security Code (AMEX card) on front above number to right  ____________
  Name of card owner as it appears on the card  ____________________________

____ I authorize ENGLISH for Life Academy to process my payment via credit or debit card using the information I have included in the Application Fee Payment section above.

____ I am paying with a personal check or money order made payable to English for Life Academy and have included my check with my completed application.



!!!  CHECK LIST !!!
1.  You have provided all the information requested on the Registration Application Form.
2.  You have verified the responses in your Personal Information section are correct.
3.  You have checked your email address for accuracy.
4.  You have attached any separate response sheets to your application.
5.  You have:

 NOW ... RUN TO THE NEAREST MAIL BOX AND DROP IN YOUR APPLICATION AND FEE PAYMENT IN AN ENVELOPE ADDRESSED TO:
Kim Carroll, Academic Director
ENGLISH for Life Academy
105 Chalet Place
Greenville, SC 29607
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