Registration Form

NEW EXTENTION
Personal Information
Family Name* : Given Names* :
Gender* : Male Female Date of Birth* (ex : 2014)
Home Address Street, City* :
Province* : Country* : Postal Code* :
Telephone No*: Fax No :
E-mail Address* : Nationality* :
Current Visa Type (If applicable)*: Student Visitor Immigrant
Working Holiday Other(Specify)
How did you hear about VIC?* Agency Internet Friends
Education Fair Newspaper/Magazine Other
Program
Full-time (25hrs/wk) Semi Full-Time (20hrs/wk) AM Part-Time (15hrs/wk)
PM Part-Time 2 (10hrs/wk) PM Part-time 1 (5hrs/wk)
Starting Date* : Duration* weeks
Current Level of English* : Beginner Lower Intermediate Intermediate Upper Intermediate Advanced
Homestay Application
I will need a homestay Duration: weeks months
Check-in date  Check-out date 
I prefer (please check) Pets No pets No preference
Children No children No preference
Other host students No other host students No preference
Do you smoke? yes no
Are you vegetarian? yes no
Allergies/Special medications / Health problems/etc :
Additional Comments or Information :
Airport Pick-up
I will need airport pick-up Pick-up Only Two ways
Date of Arrival Time of Arrival :(Pacific Standard Time)
Airline : Flight Number :
Date of Departure Time of Departure : (Pacific Standard Time)
Airline : Flight Number :
*

I declare that the information I have provided is true and correct.
I've read and understand all of VIC’s policies on admissions, dispute resolution, dismissal, refunds, English only policy, and vacation.
As such, I acknowledge that I will be held subject to the terms, conditions, and policies contained herein.
VIC Policy Fee & Refund Policy