Agency Registration

Internship in Brighton > Agency Registration

Name *

First

Last

Email *

Your Age

Your date of birth

Your address

Nationality

Sex

Please indicate what you think your standard of English is at present:

Internship field you are interested in:

Alternative internship field should your first choice be unavailable

Length of Internship required (weeks)

Is there any particular type of organisation you would prefer?

Accommodation details

You need to complete this section if you are planning to book a host family or shared student accommodation through us

Host family accommodation

Shared flat with students

Type of room

Tipe of accomodation

Do you have any other requirements?

Do you mind staying with a cat or a dog?

Any allergies or health problems we need to know?

Is there any REGULAR medication you are likely to be taking or any drugs that you are aware you are allergic to?

Declaration

I have read and understood the booking terms and conditions:

Full Name of agency representative

Student's full name

Date