Title * ---DrMrMrsMissMs
First name(s) *
Last Name *
Date of Birth (DD/MM/YYYY)*
---AlbaniaAlgeriaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsChadChileChinaColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCôte d’IvoireCroatiaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuineaGuinea-BissauGuyanaHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLesothoLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalQatarRéunionRomaniaRussiaRwandaSamoaSan MarinoSão Tomé & PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSpainSri LankaSt. HelenaSt. Kitts & NevisSt. LuciaSt. Pierre & MiquelonSt. Vincent & GrenadinesSurinameSvalbard & Jan MayenSwazilandSwedenSwitzerlandTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkmenistanTurks & Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayVanuatuVatican CityVenezuelaVietnamWallis & FutunaYemenZambiaZimbabwe
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Why are you taking the test? * ---For higher education extended course (three months or more)For higher education short course (three months or less)For other educational purposesFor registration as a doctorFor immigrationFor employmentFor professional registration (NOT medical)For personal reasonsFor registration as a nurse (including CGFNS)For registration as a dentistOther
If Other, please specify reason *
Which country are you applying/intending to go to? * ---AustraliaCanadaNew ZealandRepublic of IrelandUnited KingdomUnited States of AmericaOther
If Other, please specify country *
Passport or National Identity Card Number*
Country of Nationality*
Occupation (Sector) ---Administrative servicesAgriculture, Fishing, Forestry, MiningArts and EntertainmentBanking and FinanceCatering and LeisureConstruction IndustriesCraft and DesignEducationHealth and Social ServicesInstallation, Maintenance and Repair ServicesLaw and Legal ServicesManufacturing and Assembly IndustriesPersonal ServicesRetail TradeTechnical and ScientificTelecommunications and the MediaTransportUtilities (gas, water etc.)Wholesale TradeOther
Occupation (Level) ---Self-employedEmployer/PartnerEmployee (Senior level)Employee (Middle or Junior level)Worker in the homeRetiredStudentOther
Education Level secondary (up to 16 years)secondary (16 - 19 years)degree or equivalentpost-graduate
How many years have you been studying English? ---1 (less than)23456789 or more
Required Exam Type AcademicGeneral
Required Exam Date (DD/MM/YYYY)
Do you have a permanent disability, such as visual, hearing or specific learning difficulty, which requires special arrangements (for example, modified material, extra time, use of technology, etc.)? YesNo
If yes, please specify your requirements and other details below. You must attach origial supporting medical evidence to this form. The medical evidence must be in the form of a report prepared in a period no more than two years before the test date. Requests for modified test materials must be submitted at least 3 months before the test.
2019 © FutureEd. All Rights Reserved.
2018 © FutureEd. All Rights Reserved.