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Application Form and Student Contract
First Name: ______________________________________ Family Name: _______________________________________
Complete Mailing Address: _____________________________________________________________________________
_____________________________________________________________________________________________________
Telephone: Home: ______________________________________ Work: ______________________________________
Fax: ______________________________________ E-mail: ____________________________________________
Secondary Education : (Please indicate the name of the high school where you completed Grade 12)
Name of high school: ___________________________________________________________________________________
City where high school is located: _______________________________________ Province/State: ___________________
Post-Secondary Educational background, where applicable (degree, university): ____________________________________________________________________________________________________
Have you previously traveled or lived overseas? ____ Yes ____ No If yes, please explain particulars below. ___________________________________________________________________________________________________
Have you ever taught/tutored English as a Second/Foreign Language students before? ____ Yes ____ No
If yes, please explain particulars: _________________________________________________________________________
What is your current occupation / field of study? ____________________________________________________________
Request for Admission: I would like to register for the TESL Certificate Program- Online commencing in (Please circle):
January 14, 2010 — April 18, 2010
My deposit will be paid by: ____ Cheque/cash ____ MasterCard ____ Visa ____ Payment plan
Visa / Mastercard number (Circle one.): __________________________________________ Expiry date: ______________
I have read the information and understand the details concerning the program, deposit and fees.
Student’s Signature: __________________________________ Date: ______________
Study Abroad Canada ensures that it will deliver the program, as described on the attached pages which form part of this contract.
Signature of SAC school official: __________________________________ Date: ______________
Once we have received all your documents, we will review your application. You will be notified within two weeks whether you have been accepted into the Certificate program. (In some instances, we may choose to conduct a phone interview with you. Please indicate a phone number and times at which you may be reached.) ________________________________________________
NB: Study Abroad Canada and this form are subject to the Private Training Schools Act and Regulations of the Province of Prince Edward Island. Under this Act, Study Abroad Canada is not permitted to make any guarantees of employment. Refunds will be granted in accordance with these regulations (sections 11 and 12).
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