If you are submitting this form on behalf of a student please give your full contact
details (Name, E-Mail, Address, Telephone, Fax) and your relationship to the student;

Would you like to participate in the Volunteer Program also? Yes   No

Student/Client Personal Information

Mr Mrs Miss Ms
Your First Name;
Your Family Name;
Your Citizenship;

Your Complete Mailing Address;

Your Date of Birth:   Year;    Month;   Day (Number);

Telephone;   Fax;
E-Mail;

My English Level is: Beginner Intermediate Advanced

Your Emergency Contact

Mr Mrs Miss Ms    Relationship to you?;

First Name;
Family Name;

Complete Mailing Address;

Telephone: Fax:

What Is Your Most Recent Education or Training Completed?

General Information

• Select Course Start Date: Select your date May 31, 2004 August 30, 2004 November 1, 2004 January 3, 2005 January 31, 2005 February 28, 2005 April 4, 2005 May 2, 2005 May 30, 2005 July 4, 2005 August 1, 2005 August 29, 2005 October 3, 2005 October 31, 2005 November 28, 2005

• Would you like arrival and departure assistance?...Yes No
• Will you apply for the Homestay program?.....Yes No ...If No, where will you be staying?

Course Fees ∓ Payment Information

1. Submit this application form, by email ("Press" the "Submit" button below (once). Also, due to the unreliability of email, please print this form and either Mail or preferably Fax it to the college.
2. Once your application has been reviewed we will send you a notice.
3. We will also send an invoice outlining your fees and a signed Letter of Acceptance suitable for your Visa application. You may transfer your fees to our Bank or pay them upon arrival.
Bank details are:

Comox Valley Credit Union
202-1797 Comox Avenue, Comox,
B.C. V9M 3L9 Canada Institution Number: 809
Transit Number: 02320
Account Number: 200-0973396
Telephone Number: (+1) (250) 703-4100
Fax Number: (+1) (250) 703-4239

If this application is accepted by Comox Valley International College (CVIC) I pledge to speak only English during my course of studies, to attend at least 85% of all classes, abide by the rules of CVIC, and to carry out the direction of CVIC staff while under their supervision. I understand and agree to the contents of this application and state that to the best of my knowledge all information I have given is complete and correct. I also acknowledge that I have read and agree to the terms and conditions of the College Refund Policy.

Note: College policies on Admission , Student Conduct , Dispute Resolution and Dismissal are available in writing (by request)
or by following these links.