NEW   EXTENTION
Personal Information
  Family Name :   Given Names :
  Male   Female   Date of Birth M   D   Y  (ex : 2005)
  Mailing Address   Street, City :
  Province, Country :   Postal Code :
  Telephone No :   Fax No :
  E-mail Address :   Nationality :
  Current Visa Type (If applicable):   Student   Visitor   Working Holiday   Other(Specify)
  How did you hear about VIC?   Agency                    Internet                 Friends
           Eduction Fair     Newspaper/Magazine             Other

Program
Full-Time Part-Time PM TOEIC Medical English
Semi Full-Time Semi Part-Time TOEFL Other
Part-Time AM College Preparation Academic Communication  
  Starting Date : M   D   Y  (ex : 2005)                       Duration: weeks
  Current Level of English : Elementary Intermediate Upper Intermediate Advanced

Homestay Application
 Do you need a homeStay? Yes No                                     Duration: weeks months
 Check-in date M   D   Y                       Check-out date M   D   Y
 I prefer (please check) Pets No pets
Children No children
Other host students No other host students
 Do you smoke? yes no
 Are you vegetarian? yes no
 Allergies/Special medications / Health problems/etc:
 Additional Comments or Information :

 I will need airport pick-up       Date of Arrival       Time of Arrival (Pacific Standard Time) 
 Airline                 Flight Number