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Total Immersion Language School

Application for Registration

Surname:_____________________ Given Name:_______________________________

Middle Name:__________________Preferred Name in Class:____________________

Sex:___________________

Present Address:_______________________________________________________

(Number)

(Street)

(Until or Apt.)

____________________________________________________________________

(Town or City

(Province)

(Postal Code)

Birthdate:__________________________ Birthplace:____________________________________

Citizenship:____________________ Date of Arrival to Canada:___________________

Type of Visa:___________________Marital Status:_____________________________

Mother Tongue:_________________Second Language:__________________________

Number of Years of Language Instruction:____________________________________

Where? ___________________________

Years of School in Native Country:__________________________________________

Occupation in Native Country:______________________________________________

Presently Employed (y/n): _________________________________________________

Name of Employer:_______________________ Employer's Tel. No._______________

Preferred Time of Instruction (check appropriate boxes)

daytime________ evening________ weekdays___________ weekends______________

Write a few sentences about yourself and why you want to study English.

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Today's Date:_________________________Your Signature:_______________________________

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