Eurocentres CANADA

請先查閱學校資料，再填表格。因為在您填妥資料後，按送出鍵，您的資料將會被直接
   傳送給學校單位，故請用英文詳細填寫本表格。   Please read the school's information first,
   then fill out this form.  After you fill out this form and press "Send" button, your information will
   be submitted directly to schools. Hence,  Please fill out this form in English precisely.

　
Legal First Name:
Middle Name(s):
Family Name:
Preferred Given Name:
E-mail Address:
Gender: Male   Female
Status (Optional): Single   Married
Nationality:
Native Language:
Occupation:
Date of Birth:
Stay in Canada: from  to 
*Visa: Student   Visitor   Immigrant
Other
*Medical Insurance: Overseas   Provincial
Student Guard #
*ID:
Passport# 
*Please submit copies of these documents upon arrival
Education:
High School:
Year Graduated:
Country:
College/University:
(Business or Academic)
Total Years Studied
Major & Degree:
ESL Training in Canada
Length
Other
Length
Country:
Present Address:
Street:
City:
Province/State:
Country:
Postal Code:
Tel:
Fax:
Emergency Contact Person:
  Mr.    Ms.
Name:
Relationship:
Contact Person's Address:
Street:
City:
Province/State:
Country:
Postal Code:
Tel:
Fax:
Permanent Address:
(where your family is living)
Street:
City:
Province/State:
Country:
Postal Code:
Tel:
Fax:
State of Health: Very Good    Good    Fair    Poor
Illnesses? No    Yes: 
Allergies? No    Yes: 
Medication? No    Yes: 
Food Exemptions? No    Yes: 
Have you been abroad? No    Yes
English Assessment:
Self Assessment
Advanced
Intermediate:  High    Low
Beginner:  High    Low
TOEFL Score:      Date: 
Enclosed?    No    Yes
Other Name of Test: 
Result:       Date:   
Enclosed?    No    Yes

English level will be assessed after your arrival. You may apply for extra English Courses in addition to Seasonal, ESP and Academic Programs.
PROGRAM CHOICE AND OTHER INFORMATION
Regular ESL Programs:
(Applicants must be 16 years or older)		  
　 　
Super-Intensive Course
(30 lessons per week)		 Length:   (weeks)
Start Date: 
Location:  Vancouver   Toronto
Super-Intensive students indicate your choice of Electives* (1-2) General Language 
Cambridge (FCE/CAE) 
　
Intensive Course (25 lessons per week) Length:   (weeks)
Start Date: 
Location:  Vancouver   Toronto
Intensive students indicate your choice of Electives* (1-4) TOEFL 
Business 
General Language 
Cambridge (FCE/CAE) 
　
Basic Course (20 lessons per week) Length:   (weeks)
Start Date: 
Location:  Vancouver   Toronto
　
* All options may not be available at all times of the year or at all levels.
Seasonal, Holiday & Youth Programs: 　
Programs include airport reception, tuition, activities, & homestay (Applicants must be 16 years of age, except for Youth - Canada Language Camps)
　 　
Summer Language Holiday Vancouver    Toronto
Youth Vancouver    Toronto
Winter Language & Ski/Snowboard Vancouver
Canada Adventure Tour Vancouver
Length (weeks)
Start Date
ESP Programs  
(Applicants must be high school graduates and demonstrate a high intermediate English level)
　 　
ESL plus professional Training Vancouver    Toronto
ESL with work experience Vancouver    Toronto
(Please check the start dates carefully)
Length (weeks)
Start Date
Academic Programs
(Applicants must be high school graduates and demonstrate a high intermediate English level)
　 　
Academic Business Program (Vancouver only) Term 1    Term 1 & 2
　
Start Date January
May
September
Year  
　
* Courses offered in conjunction with BCIT(British Columbia Institute of Technology), please refer to BCIT-Eurocentres Vancouver Joint Program Refund Policy
Other Programs  
Program Name
Length (weeks)
Start Date
Airport Reception: Yes
No - How will you travel to the Host Family?
      Bus
      Taxi
      Other
        
Student Guard Medical Insurance: Yes
No - (If no, please provide a copy of your insurance on the first day of school.)
Accommodations:
Homestay: Yes
     - Full Board;  
     - Half-board  
Residence: Yes (no meals)
  Arrival  
  Departure  
  No Accommodations - please include your Vancouver or Toronto Address
Do you smoke? Yes    No
Do you want to live with smokers? Yes    No
Do you like pets? Yes    No
Do you want to live with pets? Yes    No
Do you like children? Yes    No
Do you want to live with children? Yes    No
(Eurocentres Canada cannot guarantee any of these requests)
Arrival Information:
By:
      Air
      Car
      Bus
      Train
Arrival Date:
Arrival Time:   am /  pm
Airline (Bus/Train):
Flight (Bus/Train) No.:
Depart from:
CONSENT AND ACKNOWLEDGMENT
I hereby register for this program declaring, to the best of my knowledge, that all information on this application form is correct. I will notify the appropriate Eurocentres Canada immediately in the event of any changes to any of this information. I have read and agree to abide by the Eurocentres Canada Dispute Resolution, Dismissal and Refund Policies which apply to my program(s) in addition to all other Eurocentres Canada and Homestay regulations (available upon request). I understand that I & II of all courses are interchangeable and if my first choice is not available, I will be registered in the other course which is of equal cost and hours per week. I also understand that in the event I am registering through a representative or an educational agency, they may receive compensation from Eurocentres Canada. I understand that Eurocentres Canada assume no responsibility for any representations, warranties, or agreements made on their behalf which are not solely contained in printed material produced by Eurocentres Canada.

I give Eurocentres Canada permission to release any information regarding my program to my educational agent and/or family member.
Yes   No


I give Citizenship and Immigration Canada permission to release to Eurocentres Canada any information regarding the status of my Visitor Visa and/or Study Permit.

Yes   No

(By checking No, Eurocentres Canada will not be able to request Visa information on the students behalf.)

I accept the terms of consent and acknowledgement.
PARENT / LEGAL GUARDIAN CONSENT
This section must be completed by the parent or legal guardian of any student under 18 years of age.


The participant agrees to participate in the entire program and will follow safety instructions and all Eurocentres Canada and Eurocentres Canada Host Family Rules and Regulations. The participant or legal guardian thereof also authorizes Eurocentres Canada and/or Canada Language Camps and/or the Host Family to attain medical treatment for the participant in the event it is required and agrees to the decisions and instructions given. It is understood that school staff and the Host Family are not responsible for any medical instructions, decisions and expenses.
Parent /  Guardian: Mr.  Ms. 
Name:
Relationship:
Speak English: No   Yes
 
Street:
City:
Province/State:
Country:
Postal Code:
Tel:
Fax:


I accept the terms of consent and acknowledgement.

其它申請文件  Other Required Documents
請學校通知您課程申請費金額 (如果有的話)及應如何繳付：
 Please inform me the  application fees if there is any and the payment options.　
    Yes 請通知         No  不用通知
請學校通知您其它申請文件 (如果有的話)：
 Please inform me other required application documents if there is any.
    Yes 請通知         No  不用通知

* 注意：填寫完此表格，按「送出」鍵送出後，請等待學校通知確認接受申請。後續申請程序依學校通知為依據。
Notice:  After filling out this form and pressing "Send " button, please wait for the school's confirmation of application acceptance.  The following application procedure should be based upon the school's notification.


  


按下「送出」鍵後，即自動送出您的資料給國外學校，故請勿重覆按「送出」鍵，謝謝。After completing this form, press "Send" button and your message will be automatically sent to the school, so Please don't press the button twice.   Thanks!

回首頁