Vancouver International College of English

PERSONAL INFORMATION
First Name:		*
Last Name:		*
Gender:	Male Female	*
Birth Date (DD/MM/YYYY):		*
Street Address:		*
City:		*
Province/State:		*
Postal Code:		*
Country:		*
Telephone:		*
Email:		*
Fax:
Visa Status:		*

PROGRAM INFORMATION
Program
English Speaking Level
Start Date (DD/MM/YYYY):	(Every Monday)
Number of Weeks

OTHER INFORMATION

How did you hear about VIC?

Airport pick-up

Do you require airport pickup?
Date/Time of arrival (if known):
Flight Number (if known):

Homestay info

Do you require homestay?
How long ? (weeks)
Do you prefer a family with children?
Do you prefer a family with other foreign students?
Do you prefer a family with a dog?
Do you prefer a family with a cat?
Do you smoke?
Do you have any food requirements?
Are you allergic to anything?
Do you have any medical problems? (Explain)

Do you require furnished apartment?

How many bedrooms?

Additional Information

Copyright © 2002 Vancouver International College of English , Inc. All rights reserved.
10th Floor, 549 Howe Street Vancouver, BC, Canada V6C 2C2
Tel : (604) 893-8423 Fax : (604) 893-8428 E-mail : [email protected]