Book a Tutorial Course at Basil Paterson

Surname:
First name:
Address:
City:
Postcode:
Country:
Nationality:
Date of birth: (day/month/year)
Telephone:
Mobile:
Fax:
E-mail address:
Name of parent/guardian/
next of kin:
Address
(if different from above):

Schools and Colleges Attended
For flexible tuition, please give current school only (if under 18)  

School 1:  
Name:
Address:
Dates:
Stage reached:

School 2:  
Name:
Address:
Dates:
Stage reached:

School 3:  
Name:
Address:
Dates:
Stage reached:

School 4:  
Name:
Address:
Dates:
Stage reached:

Name and address of your last Principal/Head Teacher for academic reference (full-time students only):

Examinations Taken
List all subjects whether passed or failed (if under 18)  

Exam 1  
Board:
Subject taken:
Date:
Level:
Results & grade:

Exam 2  
Board:
Subject taken:
Date:
Level:
Results & grade:

Exam 3  
Board:
Subject taken:
Date:
Level:
Results & grade:

Exam 4  
Board:
Subject taken:
Date:
Level:
Results & grade:

Exam 5  
Board:
Subject taken:
Date:
Level:
Results & grade:

Exam 6  
Board:
Subject taken:
Date:
Level:
Results & grade:

Course Details  
Type of tuition: Full-time tuition   Flexible individual tuition
Number of flexible tuition lessons required per week
Time of tuition: am   pm   weekend (*not always available)
Are you seeking entrance qualifications for college or university: yes   no

Subject 1  
Subject:
Level:
Examination date:
Examination board:

Subject 2  
Subject:
Level:
Examination date:
Examination board:

Subject 3  
Subject:
Level:
Examination date:
Examination board:

Subject 4  
Subject:
Level:
Examination date:
Examination board:

Subject 5  
Subject:
Level:
Examination date:
Examination board:

Subject 6  
Subject:
Level:
Examination date:
Examination board:

Start date:
Finish date:
What are your career objectives:

How did you hear about
Basil Paterson College?

Accommodation  
Do you wish us to arrange accommodation for you: yes   no

If yes, please give the
following information:  

Start date:
Finish date:
Do you smoke: yes   no
Please provide any other information that may be relevant (eg. hobbies, special diet, medical conditions etc):


Please note that this application form must be sent to Basil Paterson before tuition can commence. Flexible tuition must be paid on a weekly basis. If cancelling a lesson, please inform the college by 9.00am on the day of the lesson. Otherwise, the lesson must be paid for.

I have read, and agree to abide by, the Conditions of Enrolment as published by Basil Paterson Tutorial College. I am sending a non-refundable deposit of £450* (only to be paid for full-time tuition during an academic year).

For Credit and Debit Card payments, please call Basil Paterson College on +44 (0)131 225 3802.

Bank Details
Fortis Bank London
23 Camomile Street
London EC3A 7PP

Account Name: The Education & Training Co. Ltd.
Account Number: 38958501
Sort Code: 40-52-62