Click To Download Ielts Application Form

IELTS Application Form Please return to: Centre

Candidate

stamp

photo

1 Preferred Date of Test

For Office Use Only Scheme: ___________________________________________________________

_____ / _____ / _____ ( day / month / year)

Test Date _____ /______ /_____ ( day / month / year )

Second Choice

Date of Payment _____ / ______ /______ ( day / month / year)

_____ / _____ / _____ ( day / month / year )

Receipt Number

ID Checked / Absent

Administrator’s initials

(circle as appropriate) 2. Family Name _______________________________________

3 Dr Mr Mrs Miss Ms (circle as appropriate)

4. Other Name(s)____________________________________________________________________________________ (These names must be the same as the names on your national identity document) 5 Address for correspondence_________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 6 Tel.No______________ 9 ID Type:

7 Date of Birth _____ /_____ /_____ ( day / month / year)

Passport / ID Card (circle as appropriate)

8 Sex F / M (circle as appropriate)

ID Document Number___________________________________________ ( This document must be brought to the test)

For questions 10-13 please enter codes. Codes will be found at the end of the IELTS Handbook. 10 Nationality _____________

11 First Language _______________________

12 Occupation (Sector) ________________________ (Level) _________________________________ 13 Why are you taking this test? 14 Which country are you applying/intending to go to? (circle as appropriate) Australia / Canada / New Zealand / Republic of Ireland / United Kingdom / United States of America / Other 15 Which IELTS Modules are you taking?

Academic

General Training

(circle as appropriate)

16 HAVE YOU TAKEN IELTS BEFORE? Yes No (circle as appropriate) (You are not allowed to repeat the test within 3 months at any centre)

17 Most recent test detail:

Centre Name _______________________________ Date ______ / ______ / _______ ( day / month / year ) Centre Number

18 What level of education have you completed? ( circle as appropriate ) Secondary up to 16 years / secondary 16-19 years / Degree or equivalent / Post-graduate 19 How many years have you been studying English? ( circle as appropriate ) Less Than 1

1

2

3

4

5

6

7

8

9 or more

20 Please give details below where you would like your results sent to ( if known ) Name of Person / Department _____________________________________________________________________ Name of College / University / Institution _____________________________________________________________ Address ________________________________________________________________________________________ ________________________________________________________________________________________

IELTS entry requirement (Band, if known) Name of Person / Department ______________________________________________________________________ Name of College / University / Institution _____________________________________________________________ Address _______________________________________________________________________________________ _______________________________________________________________________________________ _ IELTS entry requirement (Band, if known) 21 Do you have any special needs? ____________________________________________________________________ I certify that the information on this form is complete and accurate to the best of my knowledge. I understand that I must not attempt to re-take IELTS at any centre within 3 months.

Signature _____________________________________________________________ Date ______ / ______ / ______ ( day / month / year )