PERSONAL INFORMATION
1.
Your full name
in English as indicated on your international passport or as shown on your visa to Canada
Vorname
Name
2.
Your sex
Mann
Frau
3.
Your date of birth
(DD)
Day
(MM)
Month
(YYYY)
Year
4.
Your contact information
E-mail-Adresse
Rufnummer
Land
area
phone number
(ext.)
Fax
Address
Land
Stadt
Index
street
5.
Emergency contact
Contact Name
Rufnummer
Land
area
phone number
(ext.)
6.
Nationalität
7.
What languages do you speak?
Please indicate all languages you are able to speak including your native language in comma-separated format
8.
Your level of English
Beginner
Intermediate
Upper Intermediate
Advanced
COURSE INFORMATION
9.
Your status in Canada
Tourist
Student
Arbeitsurlaub
Other
Geben Sie bitte an
10.
Your course duration
Das Anfangsdatum der Kurse
(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
TOEIC
PT1-Part Time
Cambridge FCE
SE Afternoon
Cambridge CAE
Business English
TESOL
Private lessons
How many per week
12.
How did you heard about inlingua?
Select all the options that apply to you
Internet
Freunde
Broschüre
Agency
Other
Geben Sie bitte an
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
Ja
Nein
Do you want airport reception?
Ja
Nein
Do you already have a valid flight ticket?
Please book a flight ticket soon and let us know your complete flight details
Ja
Nein
Do you want airport drop off?
Ja
Nein
Medical insurance required?
Ja
Nein
ACCOMODATION INFORMATION
14.
Accomodation Preferences
Accommodation type:
Homestay (with meals)
Rooming (no meals)
Дата начала проживания:
(DD)
Day
(MM)
Month
(YYYY)
Year
Дата окончания проживания:
(DD)
Day
(MM)
Month
(YYYY)
Year
15.
Personal details
Do you have a medical condition we should be aware of?
Ja
Nein
Geben Sie bitte an:
Do you take any medication?
Ja
Nein
Geben Sie bitte an:
Are you a vegetarian/special diet?
Ja
Nein
Geben Sie bitte an:
Do you smoke?
Ja
Nein
Please, specify if you want a family with smokers?
Ja
Nein
Do you want a family with young children?
Ja
Nein
Nicht wichtig
Do you want a family with pets (animals)?
Ja
Nein
Nicht wichtig
* 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
Название авиакомпании
Город приезда
Flug nummer
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 005 (01-08) ONLINE
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