APPLICATION FOR ADMISSION TO QUEEN ALEXANDRA’S HOUSE
Email: queenalex@compuserve.com
Fax: 020 7589 3177
Post: Queen Alexandra's House, Kensington Gore, London SW7 2QT
Please fill in this form and return it to
us by email, fax or post.
Your application must be accompanied by a
current photograph and a deposit of £300 (see notes at the bottom of this
form).
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First name :
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Surname:
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Date of birth:
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Nationality:
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Home address:
Post code:
(If contact address is different from
home address please use separate sheet)
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Telephone no:
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Fax no:
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Proposed college:
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Title and length of course:
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Length of proposed stay at Queen Alexandra's House:-
1 Term 2 Terms 3 Terms (select as required)
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Music students, please name your
instruments:
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Instrument 1:
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Instrument 2:
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Grade of room required:
A B C (select one only)
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Name and address of parent or
guardian:
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Name & address of two referees (eg house mistress, family doctor, or parish priest):
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Referee 1:
Referee’s address:
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Referee 2:
Referee’s address:
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Proposed date of entrance:
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Details of recent
educational/professional qualifications and/or employment:
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Previous educational establishment:
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What are your main interests?
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Languages spoken other than English:
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Details of any disabilities,
serious allergy, regular medication or special diets:
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Are your parents responsible for
the payment of your residential fees?
Yes: No:
If no, please give details below (or
include letter from sponsor agreeing to pay such fees)
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Please include any further information you feel is relevant to your
application:
(use an additional sheet if necessary)
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Today's date:
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Signature (or name):
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NOTES
- If you are sending your application form by post, please
remember to enclose a cheque for £300 plus a
recent photograph.
- If you wish to send your application by email, please attach a
recent photo. We will send you details of how to pay your £300 directly
into our bank account using BACS or SWIFT.
- If you send your application by fax, please also send us a
photo by post. We will send you a fax with the details of how to pay your
£300 directly into our bank account.
Queen Alexandra's House, Kensington Gore, London SW7 2QT.
T: +44 (0)20 7589 5891120 F: +44 (0)20 7589 3177
E: queenalex@compuserve.com W: www.queenalex.com