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VEGA LANGUAGE ACADEMY

2021 APPLICATION FORM

Student Information

Last Name:

Middle Name:

First Name:

Gender:
MaleFemaleOther

Nationality:

Date of Birth:

Address:

Phone Number:

City / Province:

Country:

Postal Code:

Email Address*:

Emergency Contact Person:

Relation to Student:

Emergency Contact Number:

Agent Information

Company:

Contact Person:

Contact Email:

Program Information

Course Type?
In-ClassOnline

General English

University Pathway

Business English

How many weeks?

How many hours?
2030

University or College Program (Complete below if you choose University or College Program to study)

Have you decided which College or University to apply for?
YesNo

University/College Name:

Have you applied yet?
YesNo

Program Name:

Student Service Information

Residency Room?
YesNo

Room Type?
SingleDouble

Duration (#weeks)

Airport Transport Service?
Pick-upDrop-offNo

Vega Language Academy Health Insurance (International Students are required to hold a health insurance while staying in Canada)

YesNo Duration:

Method of Payment:
Wire TransferBank DraftE-TransferChequeCredit Card (4% Transaction Fee)

Application Declaration

I declare that the information contained in this application is complete and correct. I agree to abide by the rules and regulations of Vega Language Academy. I understand and agree that acceptance of this application comes with no guarantee of admission to colleges and universities. I have read and understood the refund policy

Applicant's Signature:

Date (YYYY/MM/DD)