Institute of Lifelong Learning

University of Delhi

English Language Proficiency Course—2010

Application form for Admission

Basic/Intermediate/Advanced (Put a tick against the level you would like to join)

(If you have completed an ELPC Course offered by Delhi University earlier, at
least a C grade is necessary for joining the course at the next higher level. Attach
a copy of the Certificate in that case.)

Mention in order of preference the Centre you would like to study at:

1.
2.
3.

Name of the student (Use capital letters):_____________________________________

Address for correspondence (in Delhi): ______________________________________

Father’s/Guardian’s Name : _______________________________________________

Res.:________________________________ Mobile No.: _______________________

E-mail id:_______________________________________________

Name of the Course currently enrolled in, in DU and the year of study:
______________________________________________________________________

Name of College: ______________________________________________________

Roll. No.: _____________________________________________________________

(Please attach a photocopy of the College I-Card showing its validity and date of expiry)
Subjects taken:

1) _________________ 2) _____________________

3) _________________ 4) _____________________

1
From which class did you start studying English as a subject in school? _____________

School(s) in which you studied:

1. ___________________________________________________________________

2.____________________________________________________________________

3.____________________________________________________________________

Medium of Instruction in school: English/Hindi/Any other:_______________________

Before you joined the first year of your UG course in the University, how many years did
you study English as a subject? ____________________________________________

In your assessment, how good is your English proficiency? Circle the number that best
represents your level of proficiency in each of the skills.

Very poor Quite good

Reading: 1 2 3 4 5

Listening 1 2 3 4 5

Speaking 1 2 3 4 5

Writing 1 2 3 4 5

State in brief two reasons for joining this Course:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Declaration

I hereby declare that all the information furnished by me is correct and to the best
of my knowledge. I will abide by all the rules of the course, attend classes
regularly and participate in all the activities of this course.

Name and Signature of Applicant