1 – Personal Information | 2 – Study Selection | 3 – Homestay

Step 1 – Personal Information

    PERSONAL INFORMATION
    Family Name*
    Given Name*
    Home Address*
    Gender*
    Date of Birth*
    Postal Code*
    City*
    Province*
    Country*
    Student E-mail Address*
    Nationality*
    Phone*
    First Language*
    Emergency contact in your home country*
    Self-assessed language level* IntroductoryElementaryIntermediateUpper-intermediateAdvanced
    Status in Canada* VisitorWorking HolidayStudentOther(Please Specify)
    Please specify


    STUDY SELECTION
    General English Programs Morning English (15hrs / week)Semi-Intensive English (20hrs / week)Semi-Intensive English PM (20hrs)Intensive English (25hrs / week)
    Focus Programs Business English (25hrs / week)IELTS Preparation (25hrs / week)
    Other Programs Junior Program

    Program Start Date*
    End Date*
    Weeks*

    How did you hear about SELC? WebsiteBrochureFriend/FamilyAgencyOther

    Please specify
    Do you want SELC to arrange Medical Insurance? NoYes
    Medical Insurance Start Date
    End Date
    Days


    OPTIONS
    Working Holiday Special
    BasicSuccessProfessional
    Mirai Jibun Project
    HOMESTAY
    Do you want SELC to arrange accommodation (homestay) for you? YesNo
    Check-in Date
    Check-out Date
    Weeks
    Night
    Private Single RoomShared Room (with travelling companion only)
    Half Board (Breakfast & Dinner)Full Board (3 meals)
    Custodianship Letter (if required) YesNo

    Only for student under 18 years

    Do you smoke? YesNo

    If yes, you must agree to smoke outside

    Are you OK living with pets? YesNo
    Please specify
    Are you OK living with children? YesNo
    Please specify
    Do you have any allergies? YesNo
    Please specify
    Special requests or needs
    Airport Pick-Up Service YesNo
    Arrival Date
    Time
    Airline & Flight No.
    Note: SELC must be notified of changes in arrival details 72hours in advance in order to guarantee pick-up. If delayed in transit, please contact our emergency representative as stated on your homestay confirmation letter (the Airport pick-up service fee is non-refundable if instructions are not followed)


    Agency Details (if applicable)


    You MUST read the Conditions of Enrolment. I confirm that the information I have provided is true and that I have read, understood and agree to abide by the SELC Conditions of Enrolment.
    YesNo


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