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)Afternoon English (15hrs)Semi-Intensive English (20hrs)Semi-Intensive English PM (20hrs)
Intensive English (25hrs)Intensive English Plus (30hrs)Immersion English (35hrs)
Focus Programs Business English (25hrs)IELTS Preparation (25hrs)Pathway Program (25hrs)
Other Programs Junior ProgramEveryday English Mastery ProgramBarista in EnglishYoga in English

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 SpecialMirai Jibun ProjectTobitate
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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