Registration Form

Im applying for

Temporary visa (less than six months) Student visa (more than six months)

I want to apply for bright future program

Yes No

program options

first choice second choice

I want to enroll

English French

My level is

Beginner Intermediate and Advanced

I want to study at MIILA:

Recommended start dates

MIILA private

6H/ week = 7 lessons

MIILA Business

8H/ week = 10 lessons

Acceleration Preparation Courses (APP):

IELTS TOEFL TEFaQ

IELTS

April 27 August 17 October 21

TOEFL

January 20 May 4

TEFaQ

I will require accommodation in Montreal

Yes No

type of residence

Homestay Residence VIP Room (Standard Residence)

Meals

Homestay, 3 meals (breakfast - lunch - dinner) Homestay, 2 meals (breakfast - dinner)

Do you have any special dietary restrictions?

Yes No

Do you have any allergies?

Yes No

Do you have any special medical needs?

Yes No

Do you have any special request? tell us about it

Help us to find your host family. Please tell us about yourself:

I will take an emergency Health insurance policy with MIILA

Yes No

I will require a Custody letter (for minors under 18 years of age)

Yes No

I will require a transfer -

From the airport to Montreal From Montréal to airport

How did you find about MIILA?

Write your answer here

Acknowledgment

I certify that all the information provided by me in this application form is accurate and correct and that MILA will not be held responsible where medical information has been withheld or falsely given. I authorize MIILA to take the appropriate action in the event of a medical emergency, and I understand that I am responsible for all medical bills incurred. I acknowledge that I have read, understood and agree with terms, pledge and policies set forth in this document.

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Locate us

8255 Mountain Sights – Suite 150 | Montréal, Québec

H4P 2B5 CANADA

Phone: +57 – 311 697 42 56

Email: info@miila.com

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