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Before completing this form, please read theTERMS & CONDITIONS of registration at Canada House.
First Name:
Mr. Ms.
Single Married
Middle Name:
Date of Birth:
Family Name:
Email Address
Home Address:
Apartment. #
City or town:
State or Province: (if applicable)
Country:
Phone:
FAX:
I would like to register for:(check all that apply)
Specialized Studies:(check all that apply)
Intensive ESL Program Intensive ESL & Specialized Studies Part-Time ESL Program (Please check one below) Integrated Skills Communication Skills English for Conversation English for Business Professionals English for Business Communication English for University Preparation English for TOEIC Preparation TESL Certificate Program
English for Business Writing English for Academic Preparation English for Business Management Listening & Pronunciation TOEFL Examination Preparation TOEIC Examination Preparation
Volunteer Program: Professional Volunteer Program Social Volunteer Program
My English Level is: Beginner Intermediate Advanced
I would like to start:
I would like to end:
My visa in Canada is:
Student Visa
Visitor Visa
Working Holiday Visa
Recent TOEIC or TOEFL test?
Date of test?
Score?
Have you studied English in a foreign country before?
Yes No
If yes, how long did you study English?
WeeksMonthsYears
How did you find Canada House?
Internet
Magazine (which one?)
Friend
Guide Book (which one?)
Agent (which one?)
Other (please explain)
Are you attending the school with a friend / family member? Yes No
If yes, please tell us their name:
Airport Pick-Up?Yes No
Date of Arrival:
Airline & Flight #:
Time of Arrival:
Where will you stay in Toronto?
Homestay: Homestay Toronto Second Home Canada
Apartment Dormitory Friend Other
Emergency Contact Person
Name:
Telephone:
Sending Registration Fee?Yes No
Amount: USD$ CDN$
How are you paying the registration fee?
Secure Online Payment(on Web site)
Bank Transfer
International Money Order
Sending payment info by FAX or mail
If paying by bank transfer, you can find our bank details are here.
When paying by credit card, please use our Secure Online Payment option -- it is safe and easy. You can also send your credit card information with your printed application, by FAX or regular mail.
Sending Full Payment?Yes No
How are you making full payment?
By sending this form you agree that you have read and understand theTERMS & CONDITIONS of registration at Canada House.
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