Celta Course Application Form


Last name

First name


Date of birth

Place of birth

First Language



Telephone number



Other Languages (incl. CEFR level)

Education (incl. dates, qualifications, awarding bodies etc.)

Prior experience in teaching English as a foreign language (incl. dates, organizations etc.)

Other relevant experience (incl. dates, organizations etc.)

General Health

Do you have a history of any of the following?

Mental Health:

Anxiety  yes no

Depression  yes no


Please specify:

Physical Health:

Diabetes  yes no

Epilepsy  yes no


Please specify:

Learning differences:

Dyslexia  yes no

Dysgraphia  yes no


Please specify:

We require this information in order to be able to advise you as to the most suitable course format and to provide you with the necessary support. For example, if you have been diagnosed with dyslexia you are eligible for extended assignment deadlines.

Other relevant information


Please provide the name and email of two people who can provide you with a reference in a professional capacity, i.e. not family members or friends. Please indicate your relationship to them.


If you are a resident in Lazio, we will need you to attend a face-to-face interview. Please provide us with a selection of days and times when you would be available to come to Globally Speaking. If you live outside Lazio, we can organize a Skype/phone interview. Please indicate your availability.

Reasons for applying for the course (150-180 words)

We need to verify that your written English meets Cambridge's minimum requirements of a high C1/C2 level of proficiency.

The Data Controller of your personal data is Cambridge Assessment English.  To view their Data Protection and Privacy statement, click here
Il titolare del trattamento dei dati personali è Cambridge Assessment English. Per conoscere come vengono trattati i dati dei candidati, clicca qui.