Preferred Date of Test
Test City Location
Which IELTS test module are you taking? (Tick one box only)
Date of Birth
Please indicate which document you will be using as proof of identity and give the number below.
Passport or National Identity Card Number
Address: Please note you will only be sent one copy of your results.
Country of Nationality (Code)
Country of Nationality (Name)
First language (Code)
First language (Name)
If other, please specify
Why are you taking the test?
Which country are you applying to/intending to go to?(Tick one box only)
Where are you currently studying English (if applicable)?
What level of education have you completed?(Tick one box only)
How many years have you been studying English?(Tick one box only)
Do you have a permanent disability, such as a visual, hearing or specific learning difficulty, which requires special arrangements (for example, modified material, extra time, use of technology, etc.)?
If yes, please specify your requirements below. You must attach original supporting medical evidence to this form. The medical evidence must be in the form of a report prepared in a period no more than two years before the test date. Requests for modified test materials must be submitted at least 3 months before the test.
Country of Nationality
Why you are taking the test?
Please give details below of academic institutions/government agencies/professional bodies/employers you would like your result sent to. Add your file/case number if known. Results may be sent either electronically or by post to these organisations. Please complete all details below for the centre to correctly identify Recognising Organisations. The centre may charge a postal fee for results sent internationally or by courier. The Test Report Form will not be sent to migration or education agents. Please note that organisations you have listed below may access your results before you have received or viewed them.
A. Name of Person/Department
Name of Institution/Agency/Body/Employer
B. Name of Person/Department
C. Name of Person/Department
D. Name of Person/Department
E. Name of Person/Department