Student Form

Payer*

Account
Student
Other

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Payer Name*

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Payer Address

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Payer Email

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First Name(s) (in entirety as shown in passport)*

Invalid spacing and/or characters.

Last Name(s) (in entirety as shown in passport)*

Invalid spacing and/or characters.

Preferred Name

Student gender*

Female
Male

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Date of Birth*

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I would like custodianship

Nationality*

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Country of Residence

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Main Language

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Phone Number

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Name of school the student will be attending (including the campus name)*
Ex: Douglas College New Westminister or Burnaby South Secondary

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Start Date*

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End Date*

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Day Count

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Board Type*

Full-Board (3 meals per day)
Half-Board (Only breakfast and dinner)
Roomstay (no meals)

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Private Bathroom(Additional charges will apply)*

Yes
No

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Ok with cats*

Yes
No

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Ok with dogs*

Yes
No

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Do you have any of the listed dietary restrictions?*

Vegetarian
Vegan
Celiac
No

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If you have any special requests such as dietary restrictions and/or if you have any allergies, please indicate here.
Also if you are going to share the same room with another student and/or if you want to be placed in the same house with another student,
please indicate that student's full name here:

I'd like to be picked up at the airport*

Yes
No

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Please enter information for the arrival flight below*
If not known, write tba and 12 pm

Airline Company

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Flight Number

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Arrival Time

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I'd like to be dropped off at the airport*

Yes
No

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Please enter information for the departure flight below*
If not known, write tba and 12 pm

Airline Company

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Flight Number

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Departure Time

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Payment Confirmation

Passport

Letter of Acceptance

Other Attachments

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Student Form

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