Learn English in Canada
Please do not send money.
We will inform you after we have received this application.
Mail or Fax to: 
Aimco Services
51-165 Chandos Dr.
Kitchener, ON  Canada  N2A 4A2
FAX:  [+1] 519-895-2912
E-mail:  info@aimco-services.com 

This application form must be printed out and
faxed or mailed to the above address.  

XXXX

ACCESS Application Form for Toronto

Please fill in this form as completely as possible. 
Full Name
Street address
Street address (continued)
City
State/Province
Zip/Postal code
Country
Telephone
Fax
e-mail
alternate
e-mail
Date of birth
   example: 30/11/1980
Sex
 Male ___         Female ___
  Citizenship
English level
 Low Beginner ___   High Beginner ___  Low Intermediate ___
High Intermediate___   Advanced ___
Course Start Date
Total length of study

(Required)  

Weeks:

 
 Weeks:
Optional Programs

Please inform me of more options
  I am not interested in more options
Do you want Airport Pickup?
 No    Yes (CAN $100.00)  
Date/Time
of Arrival 
(if known)
Flight Number & Airline
(if known)
Medical Insurance
 Do you want to buy medical insurance from ACCESS? 
   (CAN $2.50/day)     Yes   No

** All ACCESS students are required to show proof of medical insurance coverage on their first day. If you do not have medical insurance from home or from ACCESS, you will be required to purchase it from us.
 

If you would like to live in a homestay please complete  the following form:
If you do not want to live in a homestay, please skip this section and move to
"Payment Method" at the end of this document.


Homestay (if required)

NOTE: While we try to fulfill homestay preferences, we cannot make
any guarantees (except in the case of allergies). 

Number of weeks in homestay
Meal Plan
Extra Options
(extra options are not always available):
 Private bathroom
(CAN $100 extra per month)
  TV in bedroom
( CAN $75 extra per month)
  Internet Connection (for your notebook computer)
(CAN $75 extra per month)

Medical Information:

Do you have any chronic medical illness?   Yes  No
If yes, please explain:

Are you currently under a doctor's care?   Yes   No
If yes, please explain:

Are you allergic to anything?    Yes   No
(e.g. medicine, smoking, food, or pets). 
If yes, please explain:

Do you smoke? Yes   No

Are you married? Yes No

What is your occupation? (if student, please tell us your field of study)

Please tell us something interesting about yourself
(your interests / hobbies)

Which type of family do you prefer?


Do you prefer a host family with children?



Do you prefer a host family with other foreign students?



Will you live with a dog ? (typical families in Canada have pets) 
Yes
No    

Will you live with a cat ?(typical families in Canada have pets)
Yes
No    

NOTE: While we try to fulfill homestay preferences, we cannot make any guarantees (except in the case of allergies). 



Payment Method:  

 

Bank Wire Transfer Bank Draft / Cheque
Do you want your Letter of Acceptance sent 
to you by courier? (DHL)
   (CAN $100 extra fee)  

No

Yes


Your Comments or Questions here:

 


I HAVE READ AND UNDERSTAND ACCESS INTERNATIONAL'S "REFUND POLICY AND CONDITIONS" AND AGREE TO ABIDE BY ALL RULES AND REGULATIONS.

I Agree           I Don't Agree

Fax or mail a hard copy of this form: 
to: 
Aimco Services - English in Canada
51-165 Chandos Dr.
Kitchener, ON  Canada  N2A 4A2
FAX:  [001] 519-895-2912
E-mail:  info@aimco-services.com
 Tel:  [001] 519-895-2880