SSILC

ONLINE REGISTRATION

Status in Canada:	Visitor Student Working Holiday Visa Permant Resident Canadian Citizen
First Name(s):
Surname/Family name(s):
Telephone Number:
Mailing address:
Postal Code:
City:
State:
Country:
E-mail address:
Date of Birth:	Year
ENROLLMENT
My application is:	Direct Through an agency
Agency:
Agent:
Agency Telephone Number:
Agency Fax Number:
Agency E-mail:

PROGRAM SELECTION

Please indicate your program dates: Indicate your choice of program and the desired start and end dates of months you would like to study:

Start Date:	Day Month Year
End Date:	Day Month Year

Full Time
Part Time

English Language Studies (Beginner to Advanced)

TEC: Teaching English To Children

TESL: Teaching English as a Second Language

Business English Communications Diploma

Academic Preparation Program

International Business Internship Program

2007 Highschool summer ESL program (Kamloops only)

TOEFL TOEIC IELTS Other

I wish to study in:

Kamloops Vancouver Victoria

Acceptance into programs will depend on eligibility of assessed level. (please see brochure for pre-requisites) and space availability.

ADDITIONAL SERVICES

I would like SSILC to arrange a family homestay for me. Please complete the
___ homestay application form.

____Homestay fees vary depending on location of studies.

I will make my own living arrangements.

AIRPORT PICKUP
($65.00 CAD) I would like SSILC to arrange airport pick-up for me.
Yes
No

MEDICAL INSURANCE ($1.75 per day CAD)
I would like SSILC to arrange medical insurance for me.

Yes
No

Have you ever studied Conversational English before?	Yes No If yes for how long?
Have you ever taken a recognized English proficiency exam before?	Yes No
If yes, your most recent score: TOEFL TOEIC Cambridge
Other:
Introductory
Elementary
Intermediate
Upper-Intermediate
Advanced

Please indicate the form of payment in which your funds will be paid.
Note: DO NOT MAIL CASH!

Personal Cheque
Visa/MasterCard
Bank Draft
Wire Transfer

All funds are payable to:

Beneficiary:	Sprott-Shaw International Language College
Bank:	Canadian Imperial Bank of Canada (CIBC)
Transit:	03820
Account #:	9266615
SWIFT:	CIBCCATT
Branch Address:	10166 King George Hwy
	Surrey, BC, V3T2W4
	Phone: (604) 586-2242

Registration Fee:	$150.00 CAD
Airport pick-up	$65.00 (if selected)
Medical Insurance:	$1.75 CAD per day (if selected)