INFORMATIONS PERSONNELLES
1.
Your full name
in English as indicated on your international passport or as shown on your visa to Canada
Prénom
Nom
2.
Your sex
Male
Female
3.
Your date of birth
(DD)
Day
(MM)
Month
(YYYY)
Year
4.
Information de contact
E-mail
Téléphone
Pays
quartier
numéro de téléphone
(ext.)
Fax
Address
Pays
City
Postal code
street
5.
Emergency contact
Contact Name
Téléphone
Pays
quartier
numéro de téléphone
(ext.)
6.
Nationality
7.
Quelles langues parlez-vous?
Merci d’indiquer toutes les langues que vous connaissez en incluant votre langue maternelle séparée par une virgule.
8.
Your level of English
Beginner
Intermediate
Upper Intermediate
Advanced
COURSE INFORMATION
9.
Your status in Canada
Visitor
Student
Working holiday
Other
Please specify
10.
Your course duration
Course Start Date
(DD)
Day
(MM)
Month
(YYYY)
Year
Course end date
(DD)
Day
(MM)
Month
(YYYY)
Year
Total number of weeks
11.
Course applied for
SE-Star-English
TOEFL
IP1-Intensive
ACP
PT1-Part Time
Cambridge FCE
SE Afternoon
Cambridge CAE
Business English
Internship / Co-Op
Private lessons
How many per week
Farmstay / Ranchstay
12.
How did you heard about inlingua?
Select all the options that apply to you
Internet
Friends
Brochure
Agency
Other
Please specify
Specify Agency and Counsellor name
13.
Answer Yes or No
Do you want accommodation? We offer two options — Homestay and Rooming both are good, safe and convenient
Yes
No
Do you want airport reception?
Yes
No
Do you already have a valid flight ticket?
Please book a flight ticket soon and let us know your complete flight details
Yes
No
Do you want airport drop off?
Yes
No
Medical insurance required?
Yes
No
ACCOMODATION INFORMATION
14.
Accomodation Preferences
Accommodation type:
Homestay (with meals)
Rooming (no meals)
Accommodation start date:
(DD)
Day
(MM)
Month
(YYYY)
Year
Accommodation end date:
(DD)
Day
(MM)
Month
(YYYY)
Year
15.
Personal details
Do you have a medical condition we should be aware of?
Yes
No
Please specify:
Do you take any medication?
Yes
No
Please specify:
Are you a vegetarian/special diet?
Yes
No
Please specify:
Do you smoke?
Yes
No
Please, specify if you want a family with smokers?
Yes
No
Do you want a family with young children?
Yes
No
Either
Do you want a family with pets (animals)?
Yes
No
Either
* Note: If you will stay for more than month in Vancouver and you are NOT sure if you want to stay in the homestay/rooming for more than the first month, please write down the end date of your course here. Failure to do so may result in additional accommodation placement fees.
* Note: Students will pay the accommodation fee and the First month ONLY.
ARRIVAL INFORMATION
16.
Arrival details
Date of arrival
(DD)
Day
(MM)
Month
(YYYY)
Year
Time of arrival
(HH)
Hours
(MM)
Minutes
Name of airline
Connecting city
Flight No
MEDICAL INSURANCE
17.
Insurance details
Start date
(DD)
Day
(MM)
Month
(YYYY)
Year
Number of days
ADDITIONAL INFORMATION
18.
Additional comments
Please, do not save my personal data on this computer
I have read and understood the
school's policies
on admissions, dispute resolution, dismissal, vacations and refunds
AFPS 006 (01-10) ONLINE
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