Application Form - VanWest College

Personal Information

First Name *

Middle Name

Last Name *

Gender *MaleFemale

Date of Birth *

DD/MM/YYYY

Nationality *

Country of Residence *

Email *

Phone *

Permanent Address

Street Address *

City *

State/Province

ZIP / Postal Code *

Country *

Emergency Contact Information

Name *

Relationship

Phone *

Email *

Program Information

English Program (ESL) - Vancouver Campus

Course

Total Weeks of Study

Lessons/week

Start Date

DD/MM/YYYY

English Program (ESL) - Kelowna Campus

Course

Total Weeks of Study

Lessons/week

Start Date

DD/MM/YYYY

Student Housing Information

ResidenceStudents must be 19 years old or older.

Room Type

Move-in Date

DD/MM/YYYY

Move-out Date

DD/MM/YYYY

Total Weeks of Stay

If selected Kelowna Copeland shared room, please provide the name of the student you will be sharing the room with.

Other Information

Airport Pick-up & Drop-offPick-up (Vancouver Airport YVR)Drop-off (Vancouver Airport YVR)Pick-up (Kelowna Airport YLW)Drop-off (Kelowna Airport YLW)None

Do you need medical insurance? *YesNo

Legal CustodianshipYes (One-time Payment $200)NoFor minors under age of 19

Medical Insurance Start Date *

DD/MM/YYYY

Medical Insurance End Date *

DD/MM/YYYY

List any special health conditions or medication.The information will be treated confidentially and will not affect judgments concerning your academic suitability.

Consent

Upload Supporting Documents

Copy of Passport / High School or College Diploma or Degree / College Attendance Certificate / Proof of English Result