Application Form

HFC International Studies
Telephone: 1-604-207-1644 Fax: 1-604-244-1664 E-mail: info@hfconsultingco.com

APPLICATION FORM

LAST NAME:

FIRST NAME:

DATE OF BIRTH (day/month/year):

NATIONALITY:

NATIVE LANGUAGE:

PASSPORT No:

COUNTRY OF RESIDENCE:

ADDRESS:

TELEPHONE:

FAX:

EMAIL:

EDUCATION:

OCCUPATION:

ESL Program

START DATE:

END DATE:

NAME OF COURSE:

LEVEL:

Beginner

Upper beginner

Lower intermediate

Intermediate

Upper intermediate

Advanced

DO YOU NEED HOMESTAY? (minimum 4 weeks):

YES

IF YES, (tick the appropriate answer):	Do you mind staying in a family with children?		YES	NO
	Can you live with pets?		YES	NO
	Do you smoke?		YES	NO
	Can you live with smokers?		YES	NO
	Do you have medical problems?		YES	NO
	Please specify:
	Do you have medical insurance?		YES	NO
	Do you have special requests regarding food?		YES	NO
	Please specify:
DO YOU NEED AIRPORT PICKUP?	YES	NO

Arrival date:

Arrival time:

Airline:

Flight number:

PAYMENT METHOD:	Bank Transfer
An invoice of your total fees will be submitted upon the receipt of your application form

How did you hear about HFConsulting Co?

Please check the Refund Policy before registering

FURTHER INFORMATION:
If you have any concerns about the security of this registration, or would like to
speak with a representative prior to completing this form, please contact us at:
1-604-207 1644 or huguette@hfconsultingco.com