Comox Valley International College (CVIC) P.O. Box 1401, Comox, British Columbia, Canada, V9N 7Z9

CVIC HIGH SCHOOL PREPARATION REGISTRATION
(This is a Secure and Confidential Document)


Date:___________________________For Office Use Only: S.R.N. ___________________________

If you are submitting this form on behalf of a student please give your full contact details (Name, E-Mail, Address, Telephone,
Fax) and your relationship to the student;

STUDENT/CLIENT PERSONAL INFORMATION

Mr Mrs Miss Ms
Your First Name
Your Family Name
You Are A Citizen of Which Country
Your Passport Number:

Your Complete Mailing Address:
Your Complete Street Address (if different from your mailing address above):

Your Date of Birth: Year: Month: Day (Number):

Telephone: Fax:
E-Mail:

My English Level is: Beginner Intermediate Advanced

Have You Studied English Before?: Yes No ......If Yes, Where and For How Long?

Who will be your emergency contact?

Mr Mrs Miss Ms Relationship to you?:

First Name:
Family Name:
Complete Home Address:
Complete Mailing Address (if different from Home Address above)
Telephone: Fax:

What Hobby(s), Sports or Special Interest(s) Do You Enjoy?

GENERAL INFORMATION

  1. I will apply for: Visitor Visa     Study Permit     Working Holiday Visa     Ministers Permit
    Other:

  2. Your Course Start Date : Year: Month: Day (Number):

  3. Until What Date Would You Like To Study:
    Year: Month: Day (Number):

  4. Would you like arrival and departure assistance?...Yes No

  5. Will you apply for the Homestay program?.....Yes No ...If No, where will you be staying?

COURSE FEES AND PAYMENT INFORMATION

1. Submit this application form and your $125 Cad. registration fee.
2. Once your application has been reviewed we will send you a notice.
3. We will also send an invoice outlining your fees and a signed Letter of Acceptance suitable for
    your Visa application.

If this application is accepted by Comox Valley International College (CVIC) I pledge to speak only English during my course
of studies, to attend at least 85% of all classes, abide by the rules of CVIC, and to carry out the direction of CVIC staff while
under their supervision. I understand and agree to the contents of this application and state that to the best of my knowledge
all information I have given is complete and correct. I also acknowledge that I have read and agree to the terms and conditions
of the College Refund Policy.

Note: College policies on Admission , Student Conduct , Dispute Resolution and Dismissal are available in writing (by request)
or by following these links.

Last modified January 9, 2004