isp application

7/29/2019 Isp Application

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STUDENT APPLICATION

PERSONAL INFORMATION

(Contact a local bank in your country and provide them with the bankinginformation given below. They will deposit the money for you in ouraccount, in trust. Attach the deposit transaction information to yourstudy permit and visa application.)

Comox Valley School District #71International Student ProgramRoyal Bank of Canada #003 Account # 102-292-0Transit # 01280, Swift Code: ROYCCAT21015 Ryan Road, Courtenay, BC V9N 3R6

Name of referring agent and agency:BCeSIS #

DO NOT FILL IN THIS BOX

HighschoolGraduation

HockeyShortTerm

Full Year

SummerJuly

Semester___ 1st or ___ 2nd

SummerAugust

What program are you are applying for :

Length of Program:

AUGUST

Please print clearly.

Name

Address

Phone

(as it appearson your passport) FAMILY NAME

STREET ADDRESS OR POST OFFICE BOX NUMBER

CITY

COUNTRY

FIRST NAME

STATE, PROVINCE OR JURISDICTION

COUNTRYCODE, ZIP CODE OR MAIL CODE

MIDDLE NAME(S)

CITYCODECOUNTRY CODE PHONE NUMBER

StudentEmail

Date of

BirthAge Male Female

YEAR DAY MONTH

IB Program(Please contact us)

School District 71 - International Student Progra805 Willemar Ave, Courtenay, B.C. Canada V9N 3L7

Phone: 1-250-703-2904 Email: [email protected]

Golf

Other Dates Requested

Grade you are applying for: _______

Please complete all parts of the application (check off each item as you proceed and attach as necessary):

Completed application form. Medical & Immunization History Letter of Reference from your Principal/Teacher

A colour copy of students Passport Course Request Activity Waiver One recent photo of yourself + one family photo

Include a Letter of Intent: Tell us why you wish to study in Canada and what your long term goals are.

Transcript of marks for the past three years:

Bank Draft / Wire payment

Visa MasterCard

Card #

Expiry date:

Cardholder:

Electronic BankingRegistration fee of $200 Cdn.:


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1. I would like to stay with a family with:

Sister(s) Yes No Brother(s): Yes No Younger Children: Yes No

2. Would you like to live in a quiet household or an active household?

3. Would you prefer to live with another international student from another country?

4. Do you wish to belong to or take part in any religious or cultural organization?

If yes, please specify

ReadingComputers/InternetPlaying Cards/Board GamesListening to music

Watching TVGoing to moviesWalking/JoggingCycling

SwimmingFitness/WorkoutBowlingTennisSchool ClubsCrafts/SewingCookingDrawing/Painting

SoccerBaseballIce hockeySkiingMartial ArtsBasketballVolleyballRacquetball

TalkativeQuietCheerfulCalmOutgoingShyPositiveIndependent

NeatActiveCasualFormal

PatientAdaptablePoliteResponsible

1. Your family consists of: Mother Father Sisters(s) Brother(s)

2. Have you ever lived away from home before? Please specify.

3. English Language Proficiency: How many years of study?________ Level of Proficiency:

4. Personality traits: Place an X in front of all activities that you participate in all characteristics that best describe you.

5. List any other hobbies and interests (including sports) you currently participate in:

7. Please attach any other information you believe is pertinent.

Beginner Intermediate Advanced

Yes No

5. Do you have any special requirements that your homestay family should be aware of?

If yes, please specify.

6. Do you smoke?

7. Give us one thing that you would like to share about yourself with your host family that will introduce you to them:

MEDICAL INFORMATION

HOMESTAY INFORMATION

MEDICAL INSURANCE IS MANDATORY IN CANADA.

CVISP PROVIDES MEDICAL INSURANCE FOR ALL INTERNATIONAL STUDENTS.

1. Do you have any pre-existing medical conditions? If yes, Please specify.

2. Are you on any medication? If yes, please specify.

3. Do you have any dietary needs? If yes, please specify:

4. Do you have any life threatening food or other allergies? If yes, please specify.

6. If I stay in Canada to Graduate high school, I will study _________________________________ at University.

No Preference

No Preference

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No


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CONFIRMATION OF ADMISSION

PARENTAL/GUARDIAN CONTACT

Father orLegalGuardian

Mother orLegal

Guardian

ParentsEmail Address:

Emergency Contact (Name, phone number, email):

Address: Check here if same as Student, if not, add information below.

Address: Check here if same as above. If not, add information below.

Date ofBirth

Date ofBirth

YEAR

YEAR

DAY

DAY

MON

MON

LAST NAME(S)

LAST NAME(S)

FIRSTNAME

FIRSTNAME

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

A. LAWS, RULES AND REGULATIONS

1. I agree to abide by the laws of Canada while a resident.

2. I will always respect cultural differences and understand that Canada is a multi-cultural country. I understand that

discrimination based on nationality, gender, political or religious affiliation is illegal in Canada

3. I agree to reside with a home stay family selected through the CVSIP Host Family program.

4. I agree not to purchase, use, or have in my possession, which includes my Host Family premises, school locker,

any drugs not prescribed for me by a doctor. This includes all hallucinogenic substances, but does not include

non-prescription remedies for minor illnesses such as colds.


any alcoholic beverages.


any weapons including firearms, air guns, knives, or martial arts implements.

7. I agree to respect the property of others and understand that any theft is a breach of the law.

8. I agree not to engage in fighting, bullying, racial taunting or similar activity.

9. I agree that I will not own, rent or drive a motor vehicle.

The following Rules of Conduct must be followed by all students enteringComox Valley International Programs.

ADDITIONAL INFORMATION WE MAY NEED TO KNOWABOUT YOUR CHILD:

B. ATTENDANCE AND SCHOOL WORK

1. I agree to attend school on a regular basis and to bring a note from the Host Family parent(s)

explaining any absence from school..

2. I agree to complete all homework and class assignments..

3. I agree to make a consistent and determined effort in my school work, to attempt to maintain

passing grades, and to maintain good work habits in all subjects.

4. I agree to obey school rules as outlined in my schools student handbook.


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School District 71 - International Student Program805 Willemar Ave, Courtenay, B. C. Canada V9N 3L7Phone: 1-250-703-2904 Email: [email protected]

AUTHORIZATION, VERIFICATION AND SIGNATURES

C. HOST FAMILY CONDUCT AND BEHAVIOUROUTSIDE THE HOME AND SCHOOL

. I understand and agree to follow the Host Familyguidelines outlined in the Student Orientation Manual,and the house rules of my host family.

. I agree not to move from my assigned Host Family andthat any move to another Host Family is arrangedthrough the Host Family Supervisor.

. In the event of a problem or disagreement with my HostFamily, I agree to notify the Host Family Supervisorpromptly who will attempt to resolve any concerns.

. I will cooperate with my Host Family and respect theirrules and guidelines.

. If I want to travel outside the Comox Valley in Canada, Iwill complete the Travel Request Form, with my Hostparents, a two weeks before departure to ask permissionfrom the Program Principal.

. I agree not to visit such places as pornographic web-

sites, adult theatres, bars, lounges, or night clubs wherealcoholic beverages are served.

D. PARENTAL AGREEMENT

1. I give permission for my child to take part in all programs sponsored

CVISP. This includes school field trips, and recreational activities

organized by the International Program staff.2. In case of serious infractions of program rules as outlined in the Stud

Agreement for SD#71, I understand that my child may be required to

return home. In this situation, I understand that there will be no refund

program fees and that I will be financially responsible for my child's r

home.3. I agree, should it become necessary, to the return home of our

son/daughter for serious medical reasons. In this case, I understand t

am responsible for travel expenses.4. I will discuss with our son/daughter, their responsibilities as an

International student as outlined in the Student Agreement for the SD

International Student Program.5. I understand that Canada is a multi-cultural country and that customs

traditions of families may be different from my own. I understand that

discrimination, based on race, philosophy, or religion is illegal in Cana6. I understand that my child will be assessed by program staff for Engl

language competency and placed in a suitable program. This may inc

ESL classes. I agree that my child will remain in ESL until the teachin

staff feel that they are ready for regular programming.7. I understand that although Canada and its communities are very safe

world standards, and that my child will be generally supervised both a

school and by the homestay family, such supervision will not be cons

and the child's constant safety cannot be guaranteed.8. I hereby waive and release and absolve and agree to indemnify

CVSD#71, the Host Family, and all Program employees, from all liabi

arising from my child's participation in the CVISP.9. I permit CVSD#71 to use photographs or images of my child in

promotional materials.

A. We acknowledge that the Comox Valley School District shall not be held liable for losses or expenses that may result from the Board being unable to prov

tuition/education owing to labor disputes or other causes beyond its control. We further acknowledge that the Comox Valley School District also reserves

right to place students in a school program that best suits the student's need for English language instruction and their academic goals.. We acknowledge that if our child's personal, educational or homestay needs are greater than those disclosed in the application process, the Comox Valley

School District has the right to charge for extra support if available, or to send the student home at the parent's expense.C. We are aware that any inaccuracy in this application or the deliberate withholding of essential information will be grounds to permit the District at its option

terminate this agreement and send the student home at the parent's expense.D. The agreement between the school district and the parents of a student in the program will be interpreted in accordance with the laws in the province of B

and any litigation involving interpretation of the agreement will be conducted in BC, Canada.. I/we understand and acknowledge that the Comox Valley SD#71's refund policy is as follows:(a) Full Refund (less application fees) if Canadian Immigration does not approve a student authorization. All requests must include the formal letter of ref

from Canadian Immigration and the original letter of acceptance issued by the International Student Program(b) Students who withdraw after the June 30th payment deadline and prior to school startup will receive a 45% refund of the tuition fee and 100% refund

any prepaid host family monthly fees. The above also applies to students who apply for the year already in progress, have a different start date than

September 1st, and who withdraw in the two months prior to their specific start date(d) Students leaving the program for whatever reason after their school start date will forfeit the entire program fee.(e) Students who are asked to withdraw due to a violation of school or program rules will receive no refund.

__________________________________________________ __________________________________________________

Name of Student Signature of Student

__________________________________________________ __________________________________________________Name of Parent or Legal Guardian Signature of Parent or Legal Guardian

__________________________________________________ __________________________________________________Name of Parent or Legal Guardian Signature of Parent or Legal Guardian

__________________________________________________Date

By signing this Application, we hereby attest to the accuracy of the information provided herein and accept responsibor said agreements, waivers and releases.

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