Please fill out this form and submit it. We will then confirm your registration, subject to availability.   PERSONAL INFORMATION Surname   Given Names   Nationality   Native Language   Birthdate                  (MM/DD/YYYY) Gender    Male     Female Address   Country   Email   Telephone      (include Country code)     PROGRAM INFORMATION Main Study Programs   Full-Time Study $1109 per month / $277.25 per week (minimum payment = 4 weeks) Part-time Study $399 per month / $99.81 per week (minimum 4 weeks) Supplementary Classes   Shyness reduction classes for ESL   $120 per month     Focused accent reduction classes   $90 per month     Focused university interview or job interview practice and counseling  $379 per month   Intensive TOEIC / IELTS classes  $409 per month     Intensive TOEFL classes  $780 per month   Course Start Preference New students start on the first Monday of each month(arrangements can be made to have students start at other times)      (MM/DD/YYYY) Anticipated Number of Weeks of Study Approximate English Level Now Beginner Intermediate Advanced     MEDICAL INSURANCE Do you want the school to arrange medical insurance for you from $2 per day plus a $20 administration fee?   No     Yes Do you smoke?   Do you have any allergies?   Do you have any existing medical conditions?     ACCOMMODATION REQUIRED Type   No accommodation required Shared Students' Apartment Homestay (stay with a Canadian family) If Homestay is desired: Note: Chelsea recommends that you stay intially in a shared student apartment and switch later to a homestay. After arriving you can visit pre-selected candidate homes and families and choose your favorite homestay.   Homestay Not Required I may choose a homestay later. (put me in a shared student apartment initially) Let Chelsea choose your homestay Do you want Premium Homestay (nicer home in nicer area) or Standard Homestay? Standard Homestay ($197.25 per week - minimum 4 weeks) Premium Homestay ($274.75 per week - minimum of 4 weeks) Will you smoke in the house?     No     Yes Can you Live with children?     No     Yes Can you Live with pets?     No     Yes  Do you have medical requirements or food restrictions? Do you want us to arrange airport pick up for you?   No    Yes How did you hear about us?         Please fill out this form and submit it. We will then confirm your registration, subject to availability.

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