Middle School Mother Tongue Tuition Registration Form - Langford International Education Consultancy

First Name of Student *

Surname of student *

Email address *Note: for safeguarding purposes, we much prefer to use school email address

GenderMaleFemaleOther

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Are you applying for Middle School Mother Tongue Language Tuition?YesNo

Do you hope to do your Mother Tongue as a Language A at IB Diploma Level?YesNo

Is your interest to maintain and develop fluency in the other tongue for other reasons?YesNo

Date of Birth *

Nationality

Student's Mother Tongue *

IB School Name *

School's Language Co-ordinator's Name

School's Language Co-ordinator's Email Address

How many years has it been since the student lived in a country where the mother tongue was spoken? *

How many years has it been since the student attended a school where the mother tongue was used as the language of instruction? *

Have the student continued to read in the mother tongue language? *YesNo

If yes, please describe some of the things that have been read recently in the mother tongue

Does the student write in the mother tongue language? *YesNo

Has the student had "formal" tutoring in the mother tongue during the past two years? (ie Saturday school, distance learning programme, private tutor, group lessons at school). Please explain: *

In addition to this mother tongue course, is the student studying other IB languages as part of the the IBMYP? Please explain:

Who is paying for your Mother Tongue Consultant tutor?

(Note: Because of Brexit, if your school is based in the EU or Switzerland, the payer must be the school or a company, not an individual EU resident.)

The School: *YesNoPartial

Family paying privately: *YesNoPartial

Parent's company, embassy or sponsoring organization: *YesNoPartial

If company please name the company:

Name of person who should receive the invoice: *

Position/Title of the person who will receive the invoice

E-mail *

Billing Address *

If the fees will be paid by a company, please province the TAX/VAT number.

Telephone number *

I have read the Terms and Conditions for ILLTC Mother Tongue Mentoring Consultancy and agree to their terms. I have read and discussed with the student the Privacy Statement along with purpose of this programme in light of the European General Data Protection Regulations (GDPR) and we have understood and agree with these Guidelines as set out by the ILLTC GDPR Policy Statement for Clients published on the website. *YesNoN/A

Name of person completing form *

Title

Email address *

Relationship to the IB Candidate (complete as appropriate) *School staff (eg IB Coordinator, Language A Coordinator, SS Coordinator)ParentRepresentative of Sponsoring Organisation or Relocation Company

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Upon receipt of the completed registration form we will contact your school (if this has been submitted by someone other than the school) and also the person who will pay the fees to confirm arrangements. We will then send the first invoice for payment, and introduce your ILLTC Teacher so the student, school and teacher can plan next steps.