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Summer Program "English in Victoria!"
Registration
English Summer Program "English in Victoria!" Summer 2006 - Registration form
Student:
Last name:
*
First Name:
*
Date of Birth:
( yyyy-mm-dd )
*
Mother tongue:
French
English
Spanish
Portuguais
Other
*
SIN / Security number:
Compulsory for bursary students (SLBP)
Sex:
Male
Female
*
Address:
( No,street, apt. )
*
City:
*
Province / State:
*
Country:
*
Postal code (zip) :
*
E-mail :
Home phone number :
(regional code)
*
Work phone number:
(regional code)
Fax number :
(regional code)
Father:
Last name:
*
First name:
*
Home phone number:
(regional code)
*
Work phone number:
(regional code)
Fax number :
E-mail :
Mother:
Last name:
*
First name:
*
Home phone number:
(regional code)
*
Work phone number:
(regional code)
Fax number :
E-mail :
Legal tutor:
Last name :
First name :
Home phone number:
(regional code)
Work phone number:
(regional code)
Fax number :
(regional code)
E-mail :
School currently attended:
School's name:
Address:
Ville:
Province:
Country:
Postal code (zip):
School degree finished in June:
*
Scholarship (OLP):
Yes
No
*
