ESL Registration Group Courses

(* Marks a required field)
Personal Information:
*Family Name: *Given Name:
Nationality: Date of Birth:

Male  Female

Contact Information:
Address: Unit/Apt:
City: Prov/State:
Postal Code: Country:
Telephone: Fax:

Language Background:
What is your first language?
What are your second languages?
Have you studied English before? Yes  No For how long?
What level of study did you complete?
Beginner Low Intermediate Intermediate High Intermediate Advanced
What is your objective in studying English?

Course Registration:
*Class Start: *Class End:
*Schedule: Intensive (5 hrs/day) Part-Time, Morning (3 hrs/day) Part-Time, Afternoon (2 hrs/day)
Do you require a home stay? Yes   No (If yes, please complete a home stay application.)
Do you require airport pick-up? Yes   No

(Please confirm flight plan a week before arrival.)
Were you referred by an agency? Yes   No Agency name?
Visa and Health Insurance:
Do you have a visa? Yes   No Not required (Canadian Citizen, Landed Immigrant, etc.)
If yes, what type of visa: Visitor   Student Visa end date:
Do you require an acceptance letter for a visa application? Yes   No  
(Note: Registration must be completed and tuition paid before an official letter of acceptance can be issued.)
Do you wish to purchase health insurance? Yes   No  
(Note: All students are required to have health insurance.)

Questions or Additional Information
If you have any question or wish to add additional information please write below.

For a registration of three months or less, all tuition fees must be paid upon registration. For periods of longer than three months, a three-month deposit must be given and the remaining fees must be paid upon arrival in Canada. [See Refund Policy]

Payment Methods
From overseas, make direct payment, by bank transfer, to:

TD Canada Trust
4422 Innes Road
Orleans, Ontario K4A 3W3
Transit No: 05636
Institution No: 004
Account No: 5225364

From Canada, payment can be made by:

Credit Card
Debit Card
(Note: If paying by bank transfer, all banking fees must be paid by the student.)