EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON

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20120802 APPENDIX 1 OF THE MASTER TEACHING AND EXAMINATION

EXAMINATION REGISTRATION

International House Newcastle, 7-15 Gallowgate, Newcastle upon Tyne NE1 4SG

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON

You must complete all sections of this form and return in person or send to: [email protected]

Examination required:

(All exams are paper based. Please tick only one option. Use a separate form for each exam.)

A2 Key (KET)		C1 Advanced (CAE)
B1 Preliminary (PET)		C2 Proficiency (CPE)
B2 First (FCE)		Fees - KET/PET: £80 FCE/CAE/CPE: £150

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON Date of exam:

IMPORTANT:

Why are you taking the exam?

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON

For studying abroad In which country?

For work

Other

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON First name(s):

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON Family name(s):

Your names must be written the same as shown on your passport/National Identity Card, in the same order.

Date of birth: (DD/MM/YY) Gender: Male Female

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON

Identification (ID):

If you are taking a Cambridge English exam in the UK, Asia, Africa and Australasia you must record the type of photo ID used to register for the exam and bring the same ID back on the Exam day otherwise you will not be allowed to sit the exam. Your ID must be current (not expired) and have a photograph.

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON ID type that you will bring to the exam:

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON ID number:

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON Expiry date of the ID listed above:

Address in Newcastle:

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON Telephone number: Email address:

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON

Permanent address (where the certificate will be sent, approximately 2-3 months after the exam):

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON

Name of institution where you are doing a Cambridge English exam preparation course:

(leave blank if you are not doing a course)

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON

Do you have any special requirements?

For example: modified materials for visual difficulties, or special requirements because of a medical condition.

Yes If ‘yes’, please specify:

Confirmation of your registration and details of the timetable for the examination days will be sent to you at least two weeks before the examination date.

The speaking exam will take place within the fortnight prior to the examination date.

Please note that the examination fees are non-refundable and non-transferable.

Please complete the relevant information on the next page

Are you 18, or over 18, years of age? Yes – Please read and sign declaration A

No – Please read and sign declaration B

Declaration A:

I understand that all individuals who want to take a Cambridge English exam are required to agree to all of the Terms and Conditions (a copy of which has been provided by the centre).

I wish to be admitted for the selected Cambridge English exam at the centre listed on this form and for the date listed here. I will bring a valid photo ID with me on the test day, and I consent to have my photo taken by the centre on the day of the speaking test and/or the written papers. I agree for this photo to be held on the secure Cambridge Assessment English Results Verification site and viewed as set out below if I give my agreement.

The photo shall only be available to organisations/individuals that I give my details to or that I authorise to view my result.

By signing this form I declare that I am aware of and agree to comply with the Terms and Conditions for this exam.

Candidate Signature: Date:

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON

Declaration B:

I am the parent/legal guardian of the candidate named on this form and I give consent to this person taking the

Cambridge English exam selected above.

I understand that all individuals who want to take a Cambridge English exam are required to agree to all of the Terms and Conditions (a copy of which has been provided by the centre).

I agree to the candidate being admitted for the selected Cambridge English exam at the centre listed on this form and for the date listed here. The candidate will bring a valid photo ID with them on the test day, and I consent to them having their photo taken by the centre on the day of the Speaking test and/or the written papers. I agree for this photo to be held on the secure Cambridge English Language Assessment Results Verification site and viewed as set out below if I give my agreement on behalf of the candidate.

The photo shall only be available to organisations/individuals that I agree to Cambridge Assessment English giving the candidate’s details to or authorise to view the candidate’s result.

By signing this form I declare that I am aware of and agree to comply with the Terms and Conditions for this exam.

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON Parent/Guardian Signature: Date:

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON Candidate Signature: Date:

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON

Other notes/requests

Please advise the centre if you have any requests, such as preferred partners for the speaking test. These cannot be guaranteed but will be taken into consideration where possible.

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON

For Reception use only:

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON Amount Paid: Date: Receipt No.:

EXAMINATION REGISTRATION INTERNATIONAL HOUSE NEWCASTLE 715 GALLOWGATE NEWCASTLE UPON Method of Payment: Signed (Reception):

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21 NAME FINAL EXAMINATION ORGANIC CHEMISTRY CHEM 220
214 PHYSICIAN ASSISTANT FLUOROSCOPY EXAMINATION COMMONWEALTH OF VIRGINIA BOARD

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