First Name*:       Last Name*:       Mr.   Mrs.    Ms. 

Birth Date*:               Email*:        Nationality*:   

Full Mailing Address:       Telephone (include country code):     

What type of Visa do you have?    Student      Visitor      Working Holiday      Other 

How did you find out about Archer?   Internet Friend Agent Studied Before Print Advertising Other   

COURSE SELECTION

Program*:    Part-time ESL      Full-time ESL      Intensive ESL      TOEFL Prep      TESL 

How many weeks would you like to study*?   

What is your current level of English?    Basic Beginner Intermediate Advanced Not Sure

If you do not need to arrange homestay through Archer, please go to the bottom of the form to submit now.

HOMESTAY DETAILS

On what date do you need your homestay to start?   

On what date will you leave your homestay?              

Do you have allergies or any medical conditions?  If yes, please explain:   

Do you have any special dietary requirements?                                              

Do you like Children?      Yes      No    please specify:   

Do you like Pets?             Yes      No    please specify:   

Do you smoke?               Yes      No

Would you like other students (from different countries) in the home?      Yes      No

My hobbies and interests are:   

Do you require airport pickup*?   Yes      No

ARRIVAL INFORMATION

I will arrive at:    Toronto Airport    Hamilton Airport

Arrival Date:              

My Flight number is:   

My Flight Time is:           am    pm   

I do not know my flight information yet.  I will send this information at a later time. 

PAYMENT DETAILS

I will pay:      Wire Transfer      Credit Card      On my first day of class

Before submitting this form, please read our Refund Policy. 

I have read, understand and agree with the terms as outlined in the Archer Education Group refund Policy*.