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Personal Information:
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| *Family Name: |
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*Given Name: |
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| Nationality: |
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Date of Birth: |
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Gender:
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Male Female
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| Contact Information: |
| Address: |
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Unit/Apt: |
| City: |
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Prov/State: |
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| Postal Code: |
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Country: |
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| Telephone: |
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Fax: |
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*Email:
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Language Background:
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| What is your first language? |
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| What are your second languages? |
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| Have you studied English before? Yes No |
For how long? |
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| What level of study did you complete? |
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| What is your objective in studying English? |
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Course Registration:
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| *Class Start: |
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*Class End: |
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| *Schedule: |
Intensive (5 hrs/day)
Part-Time, Morning (3 hrs/day)
Part-Time, Afternoon (2 hrs/day)
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| Do you require a home stay?
Yes
No |
(If yes, please complete a home stay application.) |
Do you require airport pick-up?
Yes
No
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(Please confirm flight plan a week before arrival.) |
| Were you referred by an agency?
Yes
No |
Agency name? |
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Visa and Health Insurance:
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| Do you have a visa?
Yes
No
Not required
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(Canadian Citizen, Landed Immigrant, etc.)
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| If yes, what type of visa:
Visitor
Student
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Visa end date:
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| Do you require an acceptance letter for a visa application?
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Yes
No
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| (Note: Registration must be completed and tuition paid before an official letter of acceptance can be issued.)
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| Do you wish to purchase health insurance?
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Yes
No
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(Note: All students are required to have health insurance.)
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Questions or Additional Information
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| If you have any question or wish to add additional information please write below. |
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Payment:
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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
Canada
SWIFT CODE: TDOMCATTTOR
Transit No: 05636
Institution No: 004
Account No: 5225364
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From Canada, payment can be made by:
Cheque
Cash
Credit Card
Debit Card
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| (Note: If paying by bank transfer, all banking fees must be paid by the student.) |
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