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)
Address 1:
Address 2:
City:
State-Province:
Zip-Postal Code:
Country:
Telephone:
Fax:
Country of Birth:
Date of Birth:
Gender: Male Famale
Native Language:
Will you be applying for a study Permit?: Yes No
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
From (dd/mm/yyyy):
To (dd/mm/yyyy):
for weeks:
and days:
Family language: English speaking French speaking
Do you smoke? No Yes
Do you have allergies? No Yes
Do you take daily medication? No Yes
Is there any food you cannot eat? No Yes
Spicify:
Can you live with children? No Yes
Would you mind to live with pets? No Yes
Will you require airport Transfer? NoPick-upDrop-OffRound-Trip
Please specify the arrival information:
Will you require medical insurance? No Yes
From (dd/mm/yyyy) :
To(dd/mm/yyyy) :
for weeks :
The payment of the CAD$100 registration fee is required in order for M.I.I.L.A. to process your registration.
Credit card
Money order, traveler's cheques or certified cheques in CAD$
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 Montreal, Quebec H3G 2H4 Canada
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.
