_{STUDY ENGLISH IN CANADA}

Program Application

Submitted by i.e. applicant name, parent, organization, or other:

For which ESL & Homestay Program? : VEC ESL and Homestay (Intensive Program) VIC ESL and Homestay Program EBC ESL and Homestay Program ESL Vacation Program - VHA & VEC

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Student Information:

First Name: Last Name: 

Home Address:

City/Town:   Province/State:

Country: Postal/Zip Code:

Email Address: Phone :

Gender: Male:  Female:   Nationality   Age:

Date of Birth (mm/dd/yy):   Passport No.

If you there are additional student, please fill out separate application for

each person, let us know here 

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Parent(s) Information

Parent Name(s) :

Street Address:

City/Town: Province/State:

Country: Postal/Zip Code:

e-mail: Phone:

Important: Please recheck your email and phone number for any typo.

Emergency Contact, if different than parent(s)

Name: Telephone:

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Program Requirementss

Length of the program: One month Two months Three months Four months Five months Six months Seven months Eigh months Nine months Ten months Eleven months Twelve months Other...   Other, specify

Program requested starting date: (mm/dd/yy)

Educational & Career Goals:

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Homestay Requirements

Requested Homestay Dates:

From:   (mm/dd/yy) To:  (mm/dd/yy)

Level of accommodation : Select Level... Standard Semi-Deluxe Deluxe (with private bath) Deluxe Studio Suite (with kitchen)

Without Meals:   With meals: Select meals required... with three meals with two meals, breakfast and dinner with Breakfast only without meals

Do you accept the homestay program rates?  Yes    No

Knowledge of English language:   (An English test will be scheduled)

Beginner Intermediate Advanced

Hobbies & Sports:

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Do you have one of the following types of entry Visas do you have?

Student Visa?          Visitor Visa?        Canadian Resident?

Canadian Citizen?  ** None, so far?  Other

** Please note that program acceptance letter will be required to apply for a

Student Visa from the Canadian Embassy in home your country. In order to

receive acceptance letter, you must satisfy program requirements. Upon

completion of this application, we will email you program requirements.

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Do you smoke?                                         Yes      No

IF YES, are you willing to smoke outside?    Yes      No

Do you drink Alcohol?                                Yes      No

Is a home with a pet acceptable?                Yes      No

If you selected no pets, which pets? selecting NO to pet... large dog or dogs small dogs and puppies all dogs cats birds all pets other, specify in comments

Do you have allergies?                               Yes      No

If yes, caused by:

Do you have any physical disabilities?         Yes      No

If yes, please explain:

Do you require special medical treatment?  Yes       No

If yes, please explain:

Do you need a special diet?                        Yes      No

If yes, please explain:

Additional comments, questions, concerns

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Flight information (If possible):  For Airport Pick Up...

Arrival date: (mm/dd/yyyy)    

Airline:   Flight number

Arrival time: (i.e. 00:00 hours)  PST (Vancouver Local Time)

Do you agree to Student Homestay Guidelines?  Yes      No

Do you accept our disclaimer?                              Yes      No

By submitting this application you acknowledge that you true and binding.