Instructions: Please complete the entire form in English. When the form is complete, hit the “Submit” button to send the form to M.I.I.L.A.
First Name (required)
Last Name (required)
Your Email (required)
Country of Birth:
Date of Birth:
Will you be applying for a study Permit?:
Who will pay for your course?:
Self / parents Others, please specify
Emergency contact, full name:
Emergency contact, telephone #:
How did you hear about M.I.I.L.A?:
Internet Print advertisement Word of mouth Friend / former student Agent Educational fair, please specify:
ESLFSLTOEFLEvening CoursesWinter Camp (English)Winter Camp (French)Summer Camp (English)Summer Camp (French)Other Languages (Only in Private)
Course Start Date: (dd/mm/yyyy):
Course End Date: (dd/mm/yyyy):
Total number of weeks:
How many hours per week?:
Premium Super Intensive (36 lessons/week) Premium Intensive (27 lessons/week) Semi-Intensive (18 lessons/week) Evening (9 lessons/week) Private
Current language level:
Beginner Intermediate Advanced
Will you require accommodation?
NoStandard Residence (no meal)Residence Private Bathroom (no meal)Premium Residence (no meal)Homestay (2 meals per day)Homestay (3 meals per day)Furnished Studio2-bedroom Furnished Apartment
English speaking French speaking
Do you smoke?
Do you have allergies?
Do you take daily medication?
Is there any food you cannot eat?
Can you live with children?
Would you mind to live with pets?
Will you require airport Transfer?
Please specify the arrival information:
Will you require medical insurance?
From (dd/mm/yyyy) :
for weeks :
The payment of the CAD$100 registration fee is required in order for M.I.I.L.A. to process your registration.
Money order, traveler's cheques or certified cheques in CAD$
Make payable to Montreal International Institute of Language Arts. Mail to:
Montreal International Institute of Language Arts, M.I.I.L.A.
1220 Mackay Street
Wire transfer in CAD$
Wire payment to:
Montreal International Institute of Language Arts
Account number: 5215961
Branch number: 05271
SWIFT number: TDOMCATTTOR
TD Canada Trust
999 De Maisonneuve Blvd. West
Montreal, Quebec. H3A 3L4. CANADA
Fax: +1 (514) 847-8955
LINK >> Refund and Cancellation Policy.
I have read and understood the refund and cancellation policy. I have read and understood the program costs. I am over 18 years old. By submitting this form, I hereby agree to these terms.
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