Choose your languege
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    Practical

    Program

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    Qualified

    Teachers

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    Best

    Work Experience

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    Caring

    Staff

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    Job

    Assistant

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    Great

    Location

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    A Bridge

    To Your Future

Registration Form

Personal Information:
*Title: Mr Ms
*Family Name:
*First Name:
*Date of Birth:
Citizenship:
Country:
*Telephone:
Fax:
*Email:
Address:
Study Programs:
*Choose your program(s): Intensive ESL
Practical English for Speaking
University Pathway Program
Diploma of Business Communication
Diploma of Bilingual Language Skills
TOEIC Program
IELTS Program
Work Experience Program
Bridge Program
Night School ESL
*Start Date:
*Length of Study:
English Level:
Education:
Occupation:
Accommodation:
Do you need homestay? Yes No
Starting from:

To

How many weeks:
Choose one option: Private room with 3 meals
Private room with 2 meals
Do you smoke? Yes No
Will you live with a dog? Yes No
Will you live with a cat? Yes No
Are there any food that
  you can not eat?
Yes
No
Do you have any allergies? Yes
No
Do you prefer a family with: Children
No Children
No Preference
Do you need residence? Yes No
Choose one option: * One queen bed
   October - June ($1,500 / 30 days)
   July - September ($1,900 / 30 days)

* Two twin beds
   October - June ($1,500 / 30 days)
   July - September ($1,900 / 30 days)
Starting from:

To

Medical Information:
Do you have Medical Insurance? Yes No
If no, do you want to buy
  Medical Insurance from
  CanPacific College?
Yes No
Start Date:
Length of Insurance:
Airport Arrival Information: (Optional)
Do you need airport pick-up? Yes No
Arrival Date:
Arrival Time:
Airline:
Flight Number:
Do you need airport drop-off? Yes No
Payment Information:
When we receive your Program Registration form, we will send you a confirmation of your registration within 7 days.
We will also dedicate you a detailed invoice, showing the fees for the programs you have selected.
Please indicate how you would like to make your payment.
* I will pay by: By Credit Card
In Cash (In Person only)
By Travelers Cheque
By Money Order/Bank Draft
By Bank Wire Transfer
Indicate when the payment will
  be sent to CanPacific College:
Comment:

 
 
*I confirm that I have read and I accept the terms and the conditions of the enrollment and school policy and refund policy with CanPacific College as indicated on the website.

*Marked Fields are required

  

STUDENTS CHOICE AWARD

2013 & 2014 & 2016



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