PERSONAL INFORMATION Family Name* Gender* MaleFemaleOther Given Name* Date of Birth* Home Address* Postal Code* City* Province* Country* Student E-mail Address* Phone* Nationality* ---ArgentinaAustraliaBelgiumBrazilCanadaChileChinaColombiaCzech RepublicDenmarkEgyptFinlandFranceGermanyGreeceIndiaIndonesiaIrelandIsraelItalyJamaicaJapanLithuaniaLuxembourgMalaysiaMaltaMexicoMongoliaNepalNetherlandsNew ZealandNorwayParaguayPeruPhilippinesPolandPortugalRomaniaRussiaSaudi ArabiaSerbiaSlovakiaSouth AfricaSouth KoreaSpainSwedenSwitzerland - German-speakingSwitzerland - French speakingSwitzerland - ItalianTaiwanThailandTurkeyUnited Arab EmiratesUnited KingdomUSAUruguayOther 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 Programs with Co-op* Business Foundations 100 (Certificate) (12+12 weeks)Business Foundations 200 (Certificate) (24+24 weeks)Business Foundations 400 (Diploma) (48+48 weeks)Hospitality Management 6 Month (Certificate) (12+12 weeks)Hospitality Management 1 Year (Diploma) (24+24 weeks)Hospitality Management 2 Year (Diploma) (48+48 weeks)Business Communications 100 (Certificate) (12+12 weeks)Global Client Care 150 (Certificate) (18+18 weeks) Programs 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) Pathway Option ESL(GE20) Pathway Program Start Date* End Date* Weeks* Program Schedule* Daytime (9AM start)Evening (4PM or 5PM start) Payment Plan (1 or 2 years program only) Yes ($100 administrative fee, optional) Employment Services Talent Incubator Service ($500, optional)Employment Foundation Service ($400, 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) YesNoOnly for student under 18 yearsDo you smoke? YesNoIf yes, you must agree to smoke outsideAre you OK living with pets? YesNoPlease specify Are you OK living with children? YesNoPlease specify Do you have any allergies? YesNoPlease specify Special requests or needs Airport Pick-Up Service YesNoArrival 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 Your browser does not support JavaScript!. Please enable javascript in your browser in order to get form work properly. Share this article with your friends