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Click To Download IELTS Application Form

This document is an IELTS application form. It requests information such as the candidate's preferred test date, personal details, contact information, education history, English language experience, test history if applicable, intended use of test results, and special needs or accommodations required. The candidate must sign to confirm the accuracy of the information and acknowledge the rules around re-taking the test within 3 months.

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1K views

Click To Download IELTS Application Form

This document is an IELTS application form. It requests information such as the candidate's preferred test date, personal details, contact information, education history, English language experience, test history if applicable, intended use of test results, and special needs or accommodations required. The candidate must sign to confirm the accuracy of the information and acknowledge the rules around re-taking the test within 3 months.

Uploaded by

api-3712408
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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IELTS Application Form

Please return to:


Centre Candidate
stamp photo

1 Preferred Date of Test For Office Use Only


Scheme: ___________________________________________________________
_____ / _____ / _____
Test Date _____ /______ /_____
( day / month / year)
( day / month / year )
Second Choice
Date of Payment _____ / ______ /______ Receipt Number
( day / month / year)
_____ / _____ / _____
( day / month / year )
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______________ 7 Date of Birth _____ /_____ /_____ 8 Sex F / M
( day / month / year) (circle as appropriate)
9 ID Type: Passport / ID Card ID Document Number___________________________________________
(circle as appropriate) ( 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 1 2 3 4 5 6 7 8 9
Than 1 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 )

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