|
First
and
last
names * |
Mr.
/
Ms.
|
| Date
of
Birth * |
dd
/
mm / yyyy |
| E-mail
address* |
 Nationality:
|
| Mail
address |
Street:
Apt:
City:
Province/State:
Country:
Postal Code:
|
Phone
and
Fax
Number
(Remember
to
add
your
country
and
city
code)
|
Phone:
Fax:
|
| Visa |
Student Visitor Working Holiday Other |
| How
did
you
learn
about
Archer? |
|
|
|
|
COURSE
INFORMATION |
|
|
| English
Programs
(ESL)
|
|
|
Test
Preparation |
|
|
Professional English Programs
|
|
|
|
|
CITY
and
DATES
OF
STUDY |
|
|
| ESL Dates
of
Study: |
From:
|
| |
To:
|
| Start Date TESL/Hospitality/Business |
|
City
of
Study:
|
|
If
you
wish
to
arrange
your
own
homestay,
please
go
to
the
bottom
of
the
page
and
submit
now.
If
you
require
homestay,
continue
filling
the
next
section. |
|
|
| HOMESTAY
INFORMATION |
|
|
| Homestay
Dates: |
From:
|
| |
To:
|
|
Airport
pick-up: |
|
| I
am
allergic
to: |
Other:
|
| Special
medical/diet/food
information: |
|
| Other
likes/dislikes/request: |
|
| Do you smoke: |
Yes No
(Most
Canadian
homes
are
non-smoking.
You
may
only
be
allowed
to
smoke
outside
of
the
home) |
| Do you like children: |
Yes No Please Specify: |
| Do you like pets: |
Yes No Please Specify: |
| My
hobbies
and
interests
are: |
|
| In
my
country,
I
am: |
My
job/major
is:
|
|
|
| Arrival
Information |
|
Arrival
City
and
Flight
Number
and
Time
(24hr
clock): |
Arrival City:
Flight
#:
Time:
|
| Date: |
|
| I
will
send
my
arrival
info
later:
|
|
|
|
|
Payment Details |
I will pay by: Wire Transfer Credit Card On arrival |
|
Specific
comments
or
questions?
|
|
|
|
By
submitting
this
form,
you
agree
to
have
read,
understood
and
accepted
Archer
Education
Group's
refund
policy
for
student
registration
and
homestay. |
|
|