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* AdvancedElementaryIntermediateIntroductoryUpper-intermediate
Status in Canada* VisitorWorking HolidayStudentOther(Please Specify)
Please specify


STUDY SELECTION
Study Selection with Co-op* Business Foundations 100 (Certificate) (12+12 weeks)Business Foundations 200 (Certificate) (24+24 weeks)Business Communications 100 - Co-op (Certificate) (12+12 weeks)Hospitality Management 6 Month - Co-op (Certificate) (12+12 weeks)Hospitality Management 1 Year - Co-op (Certificate) (24+24 weeks)Hospital Management 2 Year - Co-op (Diploma) (48+48 weeks)
Study Selection without Co-op* Food & Beverage Management (Certificate) (12 weeks)Introduction to Communication 101 (Certificate) (6 weeks)Business Communications 110 - No Co-op (Certificate) (12 weeks)
Daytime or Evening Study* Daytime (9AM start)Evening (4PM or 5PM start)
Program Start Date*
End Date*
Weeks*


Employment Foundation Service Basic (included)Premium ($750, optional)
Note: Please contact SELC about our Pathway Partnerships and Employment Foundation Service. Due the short duration of these programs, students must arrive with all appropriate permits valid for the entire length of their program (i.e. valid study and co-op work permits).

How did you hear about SELC? WebsiteBrochureFriend/FamilyAgencyOther
Please specify
Do you want SELC to arrange Medical Insurance? YesNo
Medical Insurance Start Date
Medical Insurance End Date
Days


HOMESTAY
Do you want SELC to arrange accommodation (homestay) for you? YesNo
Check-in Date
Check-out Date
Weeks
Nights
Private Single RoomShared Room (with travelling companion only)
Full Board (3 meals)Half Board (Breakfast & Dinner)
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 Enrollment. 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 Enrollment.
YesNo


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