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).

 

First name :          

Surname:      

Date of birth:      

Nationality:      

 

Home address:      

 

 

Post code:      

(If contact address is different from home address please use separate sheet)

Telephone no:      

Fax no:      

Proposed college:       

Title and length of course:      

Length of proposed stay at Queen Alexandra's House:-

             1 Term              2 Terms              3 Terms       (select as required)

Music students, please name your  instruments:

Instrument 1:      

Instrument 2:      

Grade of room required:

             A              B              C       (select one only)

Name and address of parent or guardian:      

 

 

Name & address of two referees (eg house mistress, family doctor, or parish priest):

Referee 1:      

Referee’s address:      

 

 

Referee 2:      

Referee’s address:      

 

 

 

Proposed date of entrance:      

Details of recent educational/professional qualifications and/or employment:

     

 

 

Previous educational establishment:      

What are your main interests?      

Languages spoken other than English:      

Details of any disabilities, serious allergy, regular medication or special diets:

     

 

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)

     

 

 

 

Please include any further information you feel is relevant to your application:

     

 

(use an additional sheet if necessary)

Today's date:      

Signature (or name):      

 

NOTES

  1. If you are sending your application form by post, please remember to enclose a cheque for £300 plus a recent photograph.
  2. 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.
  3. 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