Application Form - Young Adults Summer Package
Please select your language.
Please complete the form in ENGLISH characters
KAPLAN REPRESENTATIVE INFORMATION
Partner Name/Contact Person
Country
Email
B2B Email
AGENT INFORMATION
Agency Name
Agent Country
First Name(s)
Last Name
Telephone
Email
STUDENT INFORMATION
First Name(s)
Last Name
Date of birth
DD/MM/YYYY
Male
Female
Country of Birth
City of Birth
Nationality
Native language
Full Address
City
Postal Code
Country
Email
Telephone
English Proficiency
Type of visa
Passport number
Is the student under 18 years old?
Please select...
Yes
No
Name and surname of legal guardian for all students under 18 years of age
Home telephone number of legal guardian
Permanent address of legal guardian
Email address of legal guardian if student is under 18 years of age
SCHOOL AND COURSE INFORMATION
Start Date (DD/MM/YYYY)
Please select...
06/JULY/2026
13/JULY/2026
20/JULY/2026
27/JULY/2026
03/AUGUST/2026
10/AUGUST/2026
Course Duration
Please select...
2 weeks
3 weeks
4 weeks
5 weeks
6 weeks
7 weeks
School
Please select...
Bournemouth
Liverpool
London
Dublin
Course Name
Please select...
General
Intensive
Accommodation
Please select...
Homestay Single Full Board Package
Residence Single Full Board Package
Please note this program runs from July 4th 2026 - August 22nd 2026
ACCOMODATION
Do you have any specific requests (e.g. medical requirements, allergies, special diet, no cats/dogs?)
Yes
No
If yes, please specify:
Do you smoke?
Yes
No
MEDICAL CONDITIONS
Do you have a disability, impairment, or long-term medical condition which may affect your studies?
Yes
No
If yes, please provide medical documentation from a relevant treating professional detailing
the impact of your condition on your ability to meet academic demands. Please see our Terms
and Conditions/Application process/Health Declaration found
here
.
ADDITIONAL INFORMATION*
Travel and Medical Insurance
Would you like Kaplan Travel and Medical Insurance?
Yes
No
If not, you will need to organise and provide evidence of your own medical insurance.
Transfer
Would you like an airport arrival transfer?
Yes
No
Would you like an airport departure transfer?
Yes
No
(In case Yes, please send flight details to your Kaplan representative)
PAYMENT
At this time, I wish to pay
the full fee
the deposit
I wish to pay by credit card (please contact your advisor to arrange payment)
I would like to arrange a bank transfer. Please send me transfer details.
DECLARATION
Terms and Conditions
I confirm that I have read, understood, and agree to be bound by Kaplan’s terms and conditions detailed on page 33 and Kaplan’s privacy policy which can be found
here
.
I authorise any licensed hospital or physician to initiate medical treatment for myself in case of medical emergency or for my child if he/she is under 18 years of age. *
Contact Information