Sprott-Shaw International Language College

ID
PW

REGISTRATION

PERSONAL INFORMATION
1. Status in Canada
2. First Name
3. Family Name
4. Date of Birth
5. Telephone Number
6. E-mail Address
7. Mailing Address
8. City
9. Province
10. Postal code
11. Country

ENROLLMENT
1. My application is	Direct Through an agency
2. Agency
3. Agent
4. Agency Telephone
5. Agency Fax
6. Agency E-mail

PROGRAM SELECTION Please indicate your program dates: Indicate your choice of program and the desired start and end dates of months you would like to study:
1. City
2. Programs	ESL Power Speaking Business English Medical English HTM DTI TOEFL MELAB TEC TESL TLC
3. Time
4. Start Date
ADDITIONAL SERVICES:	Homestay Airport Pick-up Medical Insurance
·	* Please type Red Letter in order (Please,Type the red color )