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Your Name *

First Name Last Name

Date of birth *

Month Day Year

Gender *

Mother Tongue *

Are you currently studying? *

No Yes

What is the name of your school?

Select your Country of residence *

Select your Nationality *

Your E-mail Address *

Alternative E-mai Address

Phone Number *

Area Code Phone Number

Skype ID

Whatsapp Number

Area Code Phone Number

Would you like us to contact you..? *

By phone By mail By skype By Whatsapp

Would you like us to contact you by any social media platform?

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Which social media platform do you prefer to be contacted by?

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What language would you like to learn? *

Please note that you can only study English in Montreal. French courses are available in both cities

In which school would you like to study? *

Montreal Quebec Both

How many weeks would you like to study? *

When would you like to start your course? (Approximate date) *

Month Day Year

What kind or program would you like to take? *

Part-time (18 lessons) Full-time (24 lessons) Intensive (30 lessons) Super Intensive (35 lessons) Bilingual Program (42 lessons) Evening program Summer Camp Winter Camp

What kind or program would you like to take? *

Part-time (18 lessons)

Full time (24 lessons)

Intensive (30 lessons)

Super Intensive (35 lessons)

Bilingual Program (42 lessons)

Evening program

Summer or Winter Camp

Type of program

Do you need accommodation? *

Yes No

What kind of accommodation would you like to request? *

Homestay (3 meals a day) Homestay (2 meals a day) Homestay (0 meals a day) Student's residence Studio Furnished apartment

What kind of accommodation?

Homestay (3 meals a day)

Homestay (2 meals a day)

Homestay (0 meals a day)

Student's residence

Studio

Furnished appartment

Select your type of accommodation

Do you require airport pick-up? *

Yes No

Do you require airport drop-off? *

Yes No

Do you require medical insurance? *

Yes No

How did you hear about us? *

Agent Google Facebook Recommendation Information in my school Languages Canada Youtube Other

Agency name

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