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Application Form

Learn English Abroad in Canada!

Do you want to learn English abroad? Canada should be at the top of your list! At CLLC in Halifax we offer excellent programs, instructors and a fantastic living environment to practice your new English language skills.

Please fill out the application form below to start you on your exciting way to learn English as a second language in Canada!

Application Form

 Send us the Application form below and our admission officer will contact you soon. You can also call us at +902 461 9577 or Fax +902 461 0919.

First Name:
Last name:
E-mail:
Country:
Telephone:
Cell Phone:
Male / Female:
Passport Number:
Birthdate:
Home Address:
City:
Province / State, Country:
Postal Code:
Program Selection:
Start Date:
How Many Weeks:
Medical Insurance:
Do you want a Homestay?:
Do you smoke?:
Do you have allergies?:
Do you take any medications?:
Do you any health problems we should know of?:
If Yes, explain:
Do you have any special questions or concerns about Homestay?:
Do you want CLLC Pick Up Service?:
How will you arrive?:
Arrival Date (if you know):
Arrival Time:
Flight Number:
From What City will you be arriving to Halifax?:
Other Info about your arrival:
Did you use and Agent to register at CLLC?:
If Yes, what is the Agency Name?:
Was this agent helpful and informative?:
Comments about agency?:

Type the keycode in the image into the text box and click Submit to send your request.
Enter code:

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