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Required Fields.
APPLICANTS PROFILE
First Name
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Last Name
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Gender
Male
Female
Email Address
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Address
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City
*
Province/State
Postal Code
Country
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Phone Num. (including country & area code)
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Date of Birth:
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Comment
Work Phone Num. (including country & area code)
Cell Phone Num. (including country & area code)
Your Profession/Occupation
English Speaking Ability
Advanced
Intermediate
Beginner
First Language Spoken
Other Languages Spoken
How Did you find out about us
SCHOOL/WORK PLACE INFORMATION
School/Company Name
Address
Postal Code
DATE OF ENROLLMENT
Start:
End:
Other Info
FLIGHT INFORMATION
Arrvial Date
Arrival Time HH:MM AM/PM
Airline
Flight Number
Origin (city)
Need Airport Pickup
No
Yes
MORE INFORMATION ABOUT YOU
Do you have any Allergies
Medical Conditions
Taking any Medications
No
Yes
Specify If Yes
Are You a Smoker
No
Yes
Do You Drink Alcohol
No
Yes
Have Medical Insurance
No
Yes
Want a Quote for Medical Insurance
No
Yes
VISA Classification
Student
Visitor
Working Holiday
Hobbies and Interests
Would Like:
Homestay
Shared Accommodation
Independent Accommodation
If you are considering more than one kind of accommodation, please check 1 or more choices.
Do you prefer:
Children
Adults Only
Smoking
No Smoking
Pets
No Pets
Do your meals reflect any special dietary considerations (e.g. Vegetarian) (explain)
Prefer to do my own meals
No
Yes
Match with a roommate
No
Yes
Explain other preference
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