Learn English in Canada Please do not send money. We will inform you after we have received this application. Mail or Fax to:  Aimco Services 51-165 Chandos Dr. Kitchener, ON  Canada  N2A 4A2 FAX:  [+1] 519-895-2912 E-mail:  info@aimco-services.com  This application form must be printed out and faxed or mailed to the above address.

ACCESS Application Form for Toronto Please fill in this form as completely as possible.

Full Name
Street address
Street address (continued)
City
State/Province
Zip/Postal code
Country
Telephone
Fax
e-mail
alternate e-mail
Date of birth	example: 30/11/1980
Sex	Male ___       Female ___
Citizenship
English level	Low Beginner ____   High Beginner ____  Low Intermediate ____ High Intermediate ____   Advanced ____
Course Start Date	Choose... January 5, 2009 January 12, 2009 January 19, 2009 January 26, 2009 February 2, 2009 February 9, 2009 February 16, 2009 February 23, 2009 March 2, 2009 March 9, 2009 March 16, 2009 March 23, 2009 March 30, 2009 April 6, 2009 April 13, 2009 April 20, 2009 April 27, 2009 May 4, 2009 May 11, 2009 May 18, 2009 May 25, 2009 June 1, 2009 June 8, 2009 June 15, 2009 June 22, 2009 June 29, 2009 July 6, 2009 July 13, 2009 July 20, 2009 July 27, 2009 August 4, 2009 August 10, 2009 August 17, 2009 August 24, 2009 August 31, 2009 September 8, 2009 September 14, 2009 September 21, 2009 September 28, 2009 October 5, 2009 October 12, 2009 October 19, 2009 October 26, 2009 November 2, 2009 November 9, 2009 November 16, 2009 November 23, 2009 November 30, 2009 December 7, 2009 December 14, 2009 December 21, 2009 December 28, 2009 January January January
Total length of study	Choose.... 3 weeks 4 weeks 5 weeks 6 weeks 7 weeks 8 weeks 9 weeks 10 weeks 11 weeks 12 weeks 13 weeks 14 weeks 15 weeks 16 weeks 17 weeks 18 weeks 19 weeks 20 weeks 21 weeks 22 weeks 23 weeks 24 weeks 28 weeks 32 weeks 36 weeks 40 weeks 44 weeks 48 weeks 52 weeks
Course 1 (Required)	Choose your 1st course (required)... Option B: Full-Time Plus 25 hours/week Option C: Full-Time Study-Tour 25 hours/week Option E: Intensive Business English 30 hours/week Option G: Intensive TOEFL 30 hours/week Option K: Work Internship	Weeks: How many weeks? 3 weeks 4 weeks 5 weeks 6 weeks 7 weeks 8 weeks 10 weeks 11 weeks 12 weeks 13 weeks 14 weeks 15 weeks 16 weeks 17 weeks 18 weeks 19 weeks 20 weeks 21 weeks 22 weeks 23 weeks 24 weeks 28 weeks 32 weeks 36 weeks 40 weeks 44 weeks 48 weeks 52 weeks
Course 2 (Optional)	Choose your 2nd course (optional)... Option B: Full-Time Plus 25 hours/week Option C: Full-Time Study-Tour 25 hours/week Option E: Intensive Business English 30 hours/week Option G: Intensive TOEFL 30 hours/week Option K: Work Internship	Weeks: How many weeks? 4 weeks 8 weeks 12 weeks 16 weeks 20 weeks 24 weeks 28 weeks 32 weeks 36 weeks 40 weeks 44 weeks 48 weeks 52 weeks
Optional Programs	Please inform me of more options ___    I am not interested in more options ___
Do you want Airport Pickup?	No ___   Yes (CAN $100.00) ____
Date/Time of Arrival  (if known)
Flight Number & Airline (if known)
Medical Insurance	Do you want to buy medical insurance from ACCESS?     (CAN $2.50/day)     Yes ___    No ___ ** All ACCESS students are required to show proof of medical insurance coverage on their first day. If you do not have medical insurance from home or from ACCESS, you will be required to purchase it from us.

Homestay (if required) NOTE: While we try to fulfill homestay preferences, we cannot make any guarantees (except in the case of allergies).  Number of weeks in homestay No homestay 3 weeks 4 weeks 5 weeks 6 weeks 7 weeks 8 weeks 9 weeks 10 weeks 11 weeks 12 weeks 13 weeks 14 weeks 15 weeks 16 weeks 17 weeks 18 weeks 19 weeks 20 weeks 21 weeks 22 weeks 23 weeks 24 weeks 26 weeks 28 weeks 32 weeks 36 weeks 40 weeks 44 weeks 48 weeks 52 weeks Meal Plan Private Room - 3 meals/day Private Room - 2 meals/day Private Room - breakfast only Shared Room - 2 meals/day Choose your meal plan Extra Options (extra options are not always available): Private bathroom ___ (CAN $100 extra per month)   TV in bedroom ___ ( CAN $75 extra per month)   Internet Connection (for your notebook computer) ___ (CAN $75 extra per month) Medical Information: Do you have any chronic medical illness?   Yes ___  No ___ If yes, please explain: Are you currently under a doctor's care?   Yes ___  No ___ If yes, please explain: Are you allergic to anything?    Yes ___  No ___ (e.g. medicine, smoking, food, or pets).  If yes, please explain: Do you smoke? Yes ___  No ___ Are you married? Yes ___ No ___ What is your occupation? (if student, please tell us your field of study) Please tell us something interesting about yourself (your interests / hobbies) Which type of family do you prefer? Married Couple ___ Single Person ___ Not Important ___ Do you prefer a host family with children? Yes ___ No ___ Not Important ___ Do you prefer a host family with other foreign students? Yes ___ No ___ Not Important ___ Will you live with a dog ? (typical families in Canada have pets)  Yes ___ No   ___  Will you live with a cat ?(typical families in Canada have pets) Yes ___ No   ___ NOTE: While we try to fulfill homestay preferences, we cannot make any guarantees (except in the case of allergies).

Payment Method:
			Bank Wire Transfer ___		Bank Draft / Cheque ___

Do you want your Letter of Acceptance sent  to you by courier? (DHL)    (CAN $100 extra fee)

No ___ Yes ___