IELTS Application Form

d d m m y y d d m m y y

d d m m y y

d d m m y y

d d m m y y

For office use only

scheme test date

date of payment receipt number

ID checked Administrators initials

AC GT

Application form

10

Please return to:

(Centre stamp)

PLEASE WRITE IN BLOCK CAPITALS

Please turn over 1

please attach a recent

passport-sized

photograph here securely

(Note: the photograph

must not be more

than 6 months old)

1

2

4

5

6

7

8 9

please attach a second

identical signed

passport-sized

photograph here using a

paper clip

3

NOT FOR SALE

Preferred date of test second choice

Family name

Title (Dr/Mr/Mrs/Miss/Ms)

Other name(s) (these names must be the same as the names on your passport/National Identity Card and must appear in the same order.)

Address: please note you will only be sent one copy of your results. Please ensure the correct mailing address isgiven, since your results will be sent to this address.

Telephone/Mobile number

email

Date of birth Gender F M (circle as appropriate)

Please indicate which document you will be using as proof of identity and give the number below. Candidates taking the test outside their own country must present a current passport or National Identity Card.You must bring the ID document indicated below to the test. This is the only form of identity that will be acceptedon the test day. The document must be valid/not expired at registration and on the test day.

Passport National Identity Card

Passport or National Identity Card number

4949.8Y02.Print.IELTS Application Form:4949.8Y02.Print.IELTS Application Form 31/7/08 16:11 Page 1

For questions 1114 please enter codes and the name of the country and first language. Codes can be found on pages iiiv. Please take care and enter this information accurately. If the codes you enter here are incorrect, the information on your Test Report Form will also be incorrect.

11 Country or region of origin (code) 12 First language (code)

First language (name)

Country or region of origin (name)

13 Occupation (sector) if other, please specify

Occupation (level) if other, please specify

Why are you taking the test? if other, please specify

15 Which country are you applying/intending to go to? (tick one box only)

Australia Canada New Zealand Republic of Ireland United Kingdom

United States of America other, please specify

16 Which IELTS test format are you taking? (tick one box only) Academic General TrainingPlease note that it is the candidates responsibility to select the test format that best meets their needs.

The General Training module is not available on every test date.

17 Which IELTS test are you taking? pen and paper test computerised test (CB IELTS)(tick one box only) (please check availability with the centre you are applying to)

If you are taking CB IELTS are you taking the Writing Test on paper? (tick one box only) yes no

18 Have you taken IELTS (either Academic or General Training) before? yes no (go to question 19) (go to question 20)

19 Most recent IELTS test details: Centre name

Centre number date

20 Where are you currently studying English (if applicable)?

21 What level of education have you completed? (tick one box only)

secondary up to 16 years secondary 1619 years degree or equivalent post-graduate

22 How many years have you been studying English? (tick one box only)

1 (less than) 2 3 4 5 6 7 8 9 or more

23 Do you have any special needs due to ill health/medical conditions? yes no

If yes, please specify your requirements below. You must attach supporting medical evidence to this form.

Requests must be submitted at least 3 months before the test.

2

23

22

21

20

19

18

17

16

15

13

14

1211

d d m m y y


You must Provide proof of your identity (e.g. passport or national

identity card) at registration and every examination session.Second country nationals must produce a passport. This IDmust contain a number, a signature, a date of birth and a photograph.

Provide two recent identical passport-sized photographs on registration.

Only have on your desk your identification, a pen/pencil andan eraser.

Ensure mobile phones, pagers and any other electronicdevices are switched off and placed with personalbelongings outside the test room. Any candidate who does not switch off their phone/pager, or who retains one in their possession, will be disqualified.

Notify the test invigilator immediately if test day conditions inany way impede your performance.

You must not Impersonate another person or have another person

impersonate you.

Attempt to cheat, copy the work of another candidate or disrupt the test.

Use, or attempt to use, a dictionary, pager, spell-checker, electronic recorder or mobile phone for the duration of thetest. Any candidate doing so will be disqualified.

Talk to or disturb other candidates once the examination has started.

Smoke, eat or drink in the examination room.

Reproduce any part of the test in any format/medium. Any candidate doing so will have their test resultsdisqualified and be liable to prosecution.

Remove any materials used during the examination. This includes, but is not limited to, examination papers,speaking task cards, answer papers and working paper.

Make sure you attend on time Know the date, time and place of your examination and

arrive before the scheduled starting time.

If you arrive late for any of the papers, report to the supervisor or invigilator. You may not be allowed to take the examination.

Provide what you need Take into the examination room only the pens, pencils and

erasers which you need for the examination.

Correction fluid and highlighters must not be used.

Leave anything which you do not need, or which is notallowed, outside the examination room.

You may not lend anything to, or borrow anything from,another candidate during the examination.

Do not bring valuables as the test centre cannot be responsible for these.

Examination instructions Listen to the supervisor and do what you are asked to do.

Tell the supervisor or invigilator at once if you think you have not been given the right

question paper. if the question paper is incomplete or illegible.

Read carefully and follow the instructions printed on the question paper and on the answer sheet.

Fill in the details required on the front of your question paper and on your answer sheet before the start of the examination.

Advice and assistance during the examination If you are in doubt about what you should do, raise your

hand to attract attention. An invigilator will come to yourassistance.

You may not ask for, and will not be given, any explanation of the questions.

If on the day of the examination you feel that your work maybe affected by ill health or any other reason, you must informthe invigilator at the time.

Leaving the examination room You may not leave the examination room without the

permission of the supervisor or invigilator.

You can not leave your seat until all papers have been collected and you have been told you can leave.

When you leave the examination room you must leave behindany paper used for rough work clearly crossed through andany other materials provided for the examination.

Do not make any noise near the examination room.

Results are issued by test centres, usually 13 days afterthe test.

Results may be delayed or withheld where any of the Rulesand Regulations have been breached.

In exceptional circumstances, results may be delayed andyou may be required to re-take one or more modules wherethe pattern of module results is highly unusual.

Please note that institutions and organisations you have listedunder question 24 may access your results before you havereceived them by mail.

*Important: please detach this section (pages iiv) and retain for your own records.

Rules and Regulations

Advice and information

Results

Disqualification warningIf you are caught infringing any of the candidate rules and regulations your test result will

be disqualified and notification sent to any receiving institution or professional body.

Notice to IELTS Candidates

This notice has been written to help you.Read it carefully and do as you areasked. If there is anything you do notunderstand, ask the IELTS Administratoror the examination supervisor.

i

4949.8Y02.Print.IELTS Application Form:4949.8Y02.Print.IELTS Application Form 31/7/08 16:11 Page i

Afghanistan 001Albania 002Algeria 003American Samoa 004Andorra 005Angola 006Antigua and Barbuda 007Argentina 008Armenia (Republic of) 009Aruba 223Australia 010Austria 011Azerbaijan 012Bahamas 013Bahrain 014Bangladesh 015Barbados 016Belarus (Republic of) 017Belgium 018Belize 019Benin 020Bermuda 021Bhutan 022Bolivia 023Bosnia-Herzegovina 024Botswana 025Brazil 026Brunei, Darussalem 027Bulgaria 028Burkina Faso 029Burundi 031Cambodia 032Cameroon 033Canada 034Canton and Enderburys Phoenix Is 035Cape Verde 036Caroline Islands 037Cayman Islands 038Central African Republic 039Chad 040Chile 041China (People's Republic of) 042Colombia 043Comoros 044Congo 045Cook Islands 046Costa Rica 047Cte dIvoire 096Croatia (Republic of) 048Cuba 049Cyprus 050Czech Republic 051Denmark 052Djibouti 053Dominica 054Dominican Republic 055Ecuador 056Egypt 057El Salvador 058Equatorial Guinea 059Eritrea 060Estonia 061Ethiopia 062Faeroe Islands 063Falkland Islands 224Fiji 064Finland 065

France 066French Guinea 067French Polynesia 068Gabon 069Gambia 070Georgia (Republic of) 071Germany 072Ghana 073Gibraltar 074Greece 075Greenland 076Grenada 077Guadaloupe 078Guam 079Guatemala 080Guinea 081Guinea-Bissau 082Guyana 083Haiti 084Holy See 212Honduras 085Hong Kong 086Hungary 087Iceland 088India 089Indonesia 090Iran 091Iraq 092Ireland 093Israel 094Italy 095Jamaica 097Japan 098Jordan 099Kazakhstan 100Kenya 101Kiribati 102Korea, North 103Korea, South 104Kuwait 105Kyrgyzstan 226Laos 106Latvia (Republic of) 107Lebanon 108Lesotho 109Liberia 110Libya 111Liechtenstein 112Lithuania (Republic of) 113Luxembourg 114Macao 115fyr Macedonia 225Madagascar 116Malawi 117Malaysia 118Maldives 119Mali 120Malta 121Marshall Islands 122Martinique 123Mauritania 124Mauritius 125Mayotte 227Mexico 126Micronesia (Federal States of) 228Midway Islands 127Moldova (Republic of) 128

Monaco 129Mongolia 130Montenegro 131Montserrat 132Morocco 133Mozambique 134Myanmar 135Namibia 136Nauru 137Nepal 138Netherlands 139Netherlands Antilles 140New Caledonia 141New Zealand 142Nicaragua 143Niger 144Nigeria 145Niue (Cook Island) 146Norfolk Island 229Northern Mariona Islands 230Norway 147Oman 148Pakistan 149Palau 231Palestine 150Panama 151Papua New Guinea 152Paraguay 153Peru 154Philippines 155Pitcairn Island 156Poland 157Portugal 158Puerto Rico 159Qatar 160Reunion 161Romania 162Russia 163Rwanda 164San Marino 165Sao Tome and Principe 166Saudi Arabia 167Senegal 168Serbia 169Seychelles 170Sierra Leone 171Singapore 172Slovakia (Republic of) 173Slovenia (Republic of) 174Solomon Islands 175Somalia 176South Africa 177Spain 178Sri Lanka 179St. Helena 180St. Kitts-Nevis-Anguilla 181St. Lucia 182St. Pierre and Miquelon 183St. Vincent and the Grenadines 184Sudan 185Surinam 186Svalbard and Jan Mayen Islands 232Swaziland 187Sweden 188Switzerland 189Syria 190Tahiti 191

Codes to enter for questions 1114

Refer to the lists below for the codes to enter for your country or region of origin, your first language and your occupation.

If either your first language or your country or region of origin is not listed, enter '000'. Look for the closestdescription of your occupation and proposed area of study. If your work or position is not covered at all, then enter '00'.

Question 11 Country or region of origin

ii

4949.8Y02.Print.IELTS Application Form:4949.8Y02.Print.IELTS Application Form 31/7/08 16:11 Page ii

Taiwan 192Tajikistan 233Tanzania 193Thailand 194Timor-Leste 222Togo 195Tokelau 196Tonga 197Trinidad and Tobago 198Tunisia 199Turkey 200Turkmenistan 234Turks and Caicos Islands 201Tuvalu 202Uganda 203Ukraine 204United Arab Emirates 205United Kingdom 206Uruguay 207US Virgin Islands 208United States of America 209Uzbekistan (Republic of) 210Vanuatu 211Venezuela 213Vietnam 214Wallis and Futuna Islands 215Western Sahara 216Western Samoa 217Yemen (Republic of) 218Zaire 219Zambia 220Zimbabwe 221Other 000

Afrikaans 001Akan 002Albanian 003Amharic 004Arabic 005Armenian 006Assamese 007Aymara 008Azeri 009Baluchi 010Bambara 011Basque 012Bemba 013Bengali 014Bihari 015Bosnian 901Breton 016Bulgarian 017Burmese 018Byelorussian 019Catalan 020Chinese 021Creole 022Croatian 023Czech 024Danish 025Dari 026Dzongkha 027Dutch 028Efik 029English 030Estonian 031Ewe 032Faeroese 033Farsi 034Fijian 035Finnish 036Flemish 037French 038Fulani 039Ga 040Georgian 041German 042Gilbertese 043Greek 044Gujarati 045Haitian Creole 046Hausa 047Hebrew 048Hindi 049Hungarian 050Ibo/lgbo 051Icelandic 052Igala 053Indonesian 054Italian 055Japanese 056Javanese 057Kannada 058Kashmiri 059Kazakh 060Khmer 061Korean 062Kurdish 063Lao 064Latvian 065Lithuanian 066Luba 067Luo 068Luxemburgish 069Macedonian 902Malagasy 070Malay 071Malayalam 072Malinka 073Maltese 074Maori 075Marathi 076

Marshallese 077Masai 078Mende 079Mongolian 080Nepali 081Norwegian 082Oriya 083Palauan 084Punjabi 085Pashto 086Polish 087Ponapean 088Portuguese 089Pushtu 090Quechua 091Rajasthani 092Riff 093Romanian 094Romansch 095Russian 096Samoan 097Serbian 098Setswana 099Shona 100Sindhi 101Singhalese 102Slovak 103Slovene 104Somali 105Spanish 106Swahili 107Swazi 108Swedish 109Tagalog 110Tahitian 111Tamil 112Tatar 113Telugu 114Tetum 136Thai 115Tibetan 116Tigrinya 117Tongan 118Trukese 119Tulu 120Tupi/Guarani 121Turkish 122Uighur 123Ukrainian 124Ulithian 125Urdu 126Uzbek 127Vietnamese 128Wolof 129Xhosa 130Yao 131Yapese 132Yiddish 133Yoruba 134Zulu 135Other 000

Question 12 First Language

Please turn over iii

4949.8Y02.Print.IELTS Application Form:4949.8Y02.Print.IELTS Application Form 31/7/08 16:11 Page iii

Question 13 Occupation

ExampleIf you are a student enter 08 because the Sector isEducation and 7 because the Level is Student.

SectorAdministrative services 01Agriculture, Fishing, Forestry, Mining 02Arts and Entertainment 03Banking and Finance 04Catering and Leisure 05Construction Industries 06Craft and Design 07Education 08Health and Social Services 09Installation, Maintenance and Repair Services 10Law and Legal Services 11Manufacturing and Assembly Industries 12Personal Services 13Retail Trade 14Technical and Scientific 15Telecommunications and the Media 16Transport 17Utilities (gas, water etc) 18Wholesale Trade 19Other 00

LevelSelf-employed 1Employer/Partner 2Employee (Senior level) 3Employee (Middle or Junior level) 4Worker in the home 5Retired 6Student 7Other 0

Question 14 Why you are taking this test?

For higher education extended course 1(three months or more)

For higher education short course 2(three months or less)

For other education purposes 3For registration as a doctor 4For immigration 5For employment 6For professional registration (NOT medical) 7For personal reasons 8For registration as a nurse (including CGFNS) 9For registration as a dentist 10Other 0

Checklist

I have signed the Application Form.

I have provided 2 passport sized photographs(signed on the back). Photographs must meetrequirements below:

Photographs must:

be identical

be no more than 6 months old

be taken against plain background so that features are

clearly distinguishable

be undamaged

be in sharp focus and clear

be print quality of professional standard

be a close-up of the head and shoulders

show the candidate looking straight at the camera

show the candidate with a neutral expression

show the candidate with mouth closed

show the candidate with eyes open and clearly visible

not show any shadows

not show any reflection or glare on glasses

not show anything covering the face, the outlines of the

eyes, nose or mouth

I have provided all the information required.

I have enclosed the test fee. (Please note that your application will not beprocessed without this.)

I have attached a photocopy of my passport(pages showing personal identification detailsand expiry date)

iv * Important: please detach this section (pages iiv) and retain for your own records.

70 8

4949.8Y02.Print.IELTS Application Form:4949.8Y02.Print.IELTS Application Form 31/7/08 16:11 Page iv

Institution Applications

24 Please give details below of academic institutions/government agencies/professional bodies/employers you would like

your results sent to. Add your file/case number if known. Results may be sent either electronically or by post to these

institutions. The centre may charge a postal fee for results sent internationally or by courier. The Test Report Form

will not be sent to migration or education agents. Please note that institutions and organisations you have listed under

this question may access your results before you have received them by mail.

a) Name of person/department

Name of institution/agency/body/employer

File/case number

Address

b) Name of person/department


File/case number

Address

c) Name of person/department


File/case number

Address

d) Name of person/department


File/case number

Address

e) Name of person/department


File/case number

Address

Please turn over 3

24


Your rights

Information we hold on you is very broad and could include information we do not make available. If you wish to view a copy of your personal

details contained in the Application Form contact [email protected]. A charge of 10 will be made for access to this information. You also have

the right to have inaccuracies in your personal details corrected. Please contact us if you find that your information is inaccurate. Documentation

must be provided to verify the correct details.

Declaration

I certify that the information on this form is complete, true and accurate. I understand that if any other person attempts to take

the IELTS examination in my place (i.e. in place of the person whose details appear on this form), both I and such person will be liable to

prosecution. Details relating to the situation may be provided to the relevant authorities, including visa processing departments.

I understand that I will be charged the full test fee if I postpone or cancel my test within 5 weeks of the test date, unless I provide

appropriate medical evidence to support the postponement or cancellation. Only evidence of serious illness will be considered.

I understand that medical evidence must be provided within 5 days of the test date.

I understand that if I attempt to cheat, copy the work of another candidate, disrupt the test, remove or copy or attempt to remove

or copy any test materials from the examination room, engage in any form of malpractice, or do anything that might damage the integrity

and security of IELTS, I will not receive a result for the test, my test fee will not be refunded and I may be prohibited from taking IELTS tests

in future. I understand that details of any alleged cheating/malpractice may be provided to the relevant authorities, including visa processing

authorities. All alleged malpractice will be reported centrally to the Test Partners and to any relevant test centre by the centre where the

alleged malpractice occurred.

I acknowledge receipt of the document entitled IELTS Information for Candidates.

I acknowledge receipt of the Notice to IELTS Candidates document, contained on page i of this document and undertake to abide by the

regulations contained therein.

I agree an observer may attend my Speaking Test as part of the monitoring process.

I agree that a photograph may be taken of me on the test day to confirm identity.

I acknowledge that the IELTS examination is administered by British Council, IDP:IELTS Australia, and Cambridge ESOL collectively referred

to as the Test Partners, and I understand and agree that the details on this form are collected for the purposes of the IELTS test and that

these details may be disclosed to, processed and stored by the Test Partners for the purpose of such administration and that these details

and my examination results may be disclosed by the Test Partners to those academic institutions or other entities to whom I submit my

enrolment application, for the purpose of allowing such institutions or entities to verify the results of the test or to carry out an investigation in

relation to suspected fraud. If the Test Partners discover that a false or altered Test Report Form has been provided to any of these

institutions or entities the Test Partners may inform the same and provide them with my personal details and any relevant details relating to

the work I produce as part of my test taking.

I understand that my results may not be issued within 13 days of the test day if any of the Test Partners deem it necessary to review any

matter associated with my test. I understand that in exceptional circumstances I may be required to re-take one or more IELTS modules.

I understand that my personal data may be processed in an anonymous form for statistical and research purposes for the development of

Cambridge ESOL examinations. Cambridge ESOL and the centre administering the test confirm that they will not disclose personal

information about candidates to others except as stated in this Declaration or to the extent permitted by law.

I understand that the work I produce as part of the IELTS test remains the property of the Test Partners and under no circumstances will be

released to candidates or institutions/organisations, except in the investigation of alleged malpractice whereby the work I produce as part of

the IELTS test may be provided to relevant authorities.

I understand that if the details on this form are not completed my application may not be processed.

Disclaimer: The International English Language Testing System (IELTS) is designed to be but one of many factors used by academic institutions,

government agencies, professional bodies and employers in determining whether a test taker has sufficient English skills

to successfully be admitted as a student or be considered for employment. IELTS is specifically designed not to be the sole method of

determining admission or employment for the test taker. IELTS is made available worldwide to all persons, regardless of age, gender, race,

nationality or religion but it is not recommended to persons under 16 years of age.

British Council, IDP:IELTS Australia and Cambridge ESOL and any other party involved in creating, producing, or delivering IELTS shall

not be liable for any direct, incidental, consequential, indirect, special, punitive, or similar damages arising out of access to, use of,

acceptance by, or interpretation of the results by any third party, or any errors or omissions in the content thereof.

Signature Date

4EMC/4949/8Y02 UCLES 2008

d d m m y y


IELTS Application Form

Documents

Transcript of IELTS Application Form