Achievers International

Application Form

Required Fields marked with sign *

Your Details

Name*

Email*

Username*

Password*

Confirm Password*

Application Details

School/College Name*

Street Address*

Town/City*

County/State*

Country:*

Postal / Zip Code*

Phone*

City code:

Phone number:

Please confirm your email address*

Fax

City code:

Phone number:

Name of Principal/Head of School*

Additional Teacher Co-ordinator

Additional Email Address

Number of students in the group*

Programme Details

Will the programme be part of the curriculum, or an after-school activity? Please give details here.

Age of participating students*

Academic Year Start Date*

Academic Year Finish Date*

How many partner groups do you wish to work with?*

One partner (Fee £100 GBP)

Two partners (Fee £150 GBP)

Three partners (Fee £200 GBP)

Four partners (Fee £250 GBP)

Partner Details

If you have a specific shool you wish to work with, please give their details. Also state whether they have confirmed this partnership with you.

Additional Information

Please provide any additional information which we should be aware of when partnering your group.

Further Information

Confirm Position

Please confirm your Title/Position

Introductions

Have you encouraged any other teachers to join Achievers International? If so, please give their contact details.

Confirm Name

Please confirm your name

I have read and agree. TC

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