Application Form

For more information on getting a Canadian VISA - Click Here

To Download a 2010 Student Fee and Application Package - Click Here

Heartland International English School
161 Portage Avenue - Room 401
Winnipeg, Manitoba, Canada
R3B 0Y4

Telephone:	1 (204) 989-8448
Fax:	1 (204) 989-2232
E-mail:	info@HeartlandEnglish.com

Last (Family) Name
First Name	Male Female
Email Address
Address
City
Province/State
Country
Postal Code
Telephone
Fax
Citizenship
Birthdate	e.g. 1975/05/30
Age	(at start of course)
Visa Classification	Student Visitor Working
What is your current level of English?
Which course are you applying for?
When do you wish to begin?

Homestay Information

Which best describes you?	quiet sociable outgoing
Any medical conditions?
Any allergies?
Would you live with a family that:
has children?	yes no doesn't matter
has pets?	yes no doesn't matter
smokes?	yes no doesn't matter
has another international student?	yes no doesn't matter

Fee Summary

Tuition	Weeks	$
Application Fee	$100	$100
Do you need a homestay?	Yes No
Homestay Placement Fee	$200	$
Homestay Fee	Weeks	$
Homestay Under 18 Surcharge	Weeks	$
Custodianship Application Fee	$100	$
Do you need Airport Pick-up? (airport pickup is free)	Yes No
Flight information:
Arrival date:
Arrival time:
Airline:
Flight number:
Do you have medical insurance?	Yes No
	$1.80 / day	$
If yes, please indicate:
Insurance Provider:
Policy #:
Dates of Coverage:
Total Fees		$

FEES ARE SUBJECT TO CHANGE, UNLESS PAID IN ADVANCE. ALL FEES SHOULD BE PAID DIRECTLY TO THE SCHOOL. HEARTLAND INTERNATIONAL ENGLISH SCHOOL ASSUMES NO RESPONSIBILITY FOR MONEY PAID TO COMPANIES OR INDIVIDUALS CLAIMING TO REPRESENT THE SCHOOL.

- HEARTLAND INTERNATIONAL ENGLISH SCHOOL WILL NOT BE LIABLE IN ANY WAY TO THE STUDENT FOR LOSS, DAMAGE, OR INJURY TO PERSONS OR PROPERTY HOWSOEVER CAUSED.

- ALL FEES SHOULD BE PAID IN CANADIAN DOLLARS.

I ACKNOWLEDGE THAT I AM FULLY RESPONSIBLE FOR MY OWN MEDICAL INSURANCE. I HAVE READ, UNDERSTOOD AND AGREE TO COMPLY WITH SCHOOL POLICY REGARDING TUITION FEES AND REFUNDS. IF I BECOME ILL OR INCAPACITATED, HEARTLAND INTERNATIONAL ENGLISH SCHOOL AND ITS EMPLOYEES MAY TAKE ANY REASONABLE ACTION THEY DEEM NECESSARY FOR MY OWN SAFETY AND WELL-BEING.

Want to be a Heartland Homestay Family?

Click for more details..