Part Time Intensive English (Mornings only) Registration Form

(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;
Your Citizenship;

Your Complete Mailing Address;

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

Telephone;   Fax;
E-Mail;

My English Level is: Beginner Intermediate Advanced

Your Emergency Contact

Mr Mrs Miss Ms    Relationship to you?;

First Name;
Family Name;

Complete Mailing Address;

Telephone: Fax:

What Is Your Most Recent Education or Training Completed?

1. I will be participating in the Community Volunteer Plan: ...... Yes No

This Volunteer program is available to all full-time students studying three months or longer. For students studying for a shorter period we will make every effort to identify a beneficial program. However, please understand that such placements might be limited.

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 & Payment Information

1. Submit this application form, by email ("Press" the "Submit" button below. Also, due to the unreliability of email, please print this form and either Mail or preferably Fax it to the college.
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 Wednesday, 21-Nov-2007 19:38:49 PST