*Family Name:

*Given Name:

*Date of Birth:
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Gender:
select... Male Female

Nationality:

Native Language:

Current Occupation:

*Country:

Select ... AfghanistanAkrotiriAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAshmore and Cartier IslandsAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBassas da IndiaBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCoral Sea IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDhekeliaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaEuropa IslandFalkland Islands (Islas Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic LandsGabonGambia, TheGaza StripGeorgiaGermanyGhanaGibraltarGlorioso IslandsGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJan MayenJapanJerseyJordanJuan de Nova IslandKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontserratMoroccoMozambiqueNamibiaNauruNavassa IslandNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParacel IslandsParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSpratly IslandsSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTromelin IslandTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin IslandsWake IslandWallis and FutunaWest BankWestern SaharaYemenZambiaZimbabwe

*Address 1:

Address 2:

City:

State/Prov:

Postal Code:

Phone:

Fax:

Mobile:

*Email:

Type of Permit:
Select... Visitor Study Other

Highest Level of Education:
Select...... Elementary School Secondary School High School Diploma College Diploma University Diploma Post Graduate Degree Other

Have you completed an English Course?:
Select...... Yes No

When?:
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Where?:

Course Duration? (Number of months):

Level Completed?:
Select...... Beginner Intermediate Advanced

Your current level of English is?:
Select...... Beginner Intermediate Advanced

Which language would you like to learn?:
select... English French Other

*Which program(s) are you interested in?:
Immersion 15
Immersion 20
Immersion 25
Immersion 30
IELTS Preparation
TOEFL Preparation
FCE (First Certificate in English) Preparation
Winter Study Tours
Summer Study Tours
Spring Study Tours
Fall Study Tours
Semi-Private lessons
Customized programs

*On which Monday would you like to start?:

*How many weeks would you like to study?:

Do you require airport pickup? :
select... One-way Two-way No

Do you want Homestay?:
select... Yes No

Do you need a student visa?:
select... Yes No

Comments:

Terms and Conditions:
TERMS AND CONDITIONS General Procedures There are no classes on session start dates or on Canadian holidays. A student is expected to attend all classes, participate in class and complete all assignments. This will ensure that the student will proceed to the next level of instruction. A student is expected to speak English while on school premises. A student is required to have Medical Insurance and provide proof. If this is not the case an insurance policy must be purchased on the first day of class. Proper travel documents and visas are the student's responsibility. All payments must be made in full before the program begins. Payments may be made by visa, money transfer, bank draft, or traveler's cheques. Refund Procedures prior to students arriving in Canada A written notice of cancellation or withdrawal is required notifying Estrie of the circumstances for the cancellation or withdrawal. The registration fee and the placement fee are non refundable at all times. A student who is denied authorization to study in Canada by the Canadian Embassy or Consulate will receive a refund for the course. A copy of the letter of refusal from Canada must be submitted, before refund is issued. Under no circumstances are any refunds given after a student visa or tourist visa is obtained, or after students have arrived in Canada and commence their studies at Estrie International Language School. Four week written notice is required for Homestay Accommodation refund or withdrawal. Refunds are only made to the person or Agent who made the payment to Estrie.
*I have read and agree to the Estrie Refund Policy: * Yes