Work Experience Program Application Form

Student Information Please type or print in black ink and check () box, where appropriate. All information must be completed. Do not leave ay blanks. Incomplete information may delay the processing of this application or will NOT be accepted. Family Name______________________________ First Name________________________________ Middle Name__________________________ Complete Mailing Address: _____________________________________________________________ Street Address __________________________________________________________________________________ City Country Zip Code Telephone No.______________________________E-mail: ____________________________________ Fax No.___________________________ Passport No. (if known) Date of Birth (Month) _____ (Day) _____ (Year) _____Place of Birth (City)________________________ Country__________________________ Country of Legal Permanent Residence _______________________ Country of Citizenship___________________________________ Sex: Male Female

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Date of Application (Month) ______ (Day)_______ (Year)_______ In emergency contact: (Phone number)________________________________ Name: ___________________________________________________________ Address: ___________________________________________________________________________ Street City Country Zip Code E-mail Their Relationship to You: ______________________________________________________

Language Ability: Beginner Advanced Beginner Intermediate Advanced Excellent Test for English taken (please give score) TOEFL________ TOEIC________ SLEP________ Other___________ Languages other than English: _____________________________________________________ English Schools and/or English courses taken: _________________________________________ Study Information All students must apply for a work permit before entering Canada (http://www.cic.gc.ca/english/study/workcoop.asp#who) Please indicate the program name you will attend and start date: 4 months English WEP (2 months Academic Study and 2 months Paid Internship) 6 months English WEP (3 months Academic Study and 3 months Paid Internship) 8 months English WEP (4 months Academic Study and 4 months Paid Internship) 10 months English WEP (5 months Academic Study and 5 months Paid Internship) 12 months English WEP (6 months Academic Study and 6 months Paid Internship) 14 months English WEP (7 months Academic Study and 7 months Paid Internship) 16 months English WEP (8 months Academic Study and 8 months Paid Internship) 18 months English WEP (9 months Academic Study and 9 months Paid Internship) 20 months English WEP (10 months Academic Study and 10 months Paid Internship)

Program start date 2010: January 4 July 12 January 25 February 22 March 22 April 19 May 17 June 14

August 9

September 8

October 4

November 2

November 29

Accommodation Do you smoke? Yes No Do you like pets? Yes No

Hobbies and Interests: ____________________________________________________________________ Any Allergies or Medical Conditions Yes No If YES, Please write detail information _______________________________________________________ Placement Preference: Family with no children Family with young children Family with teenagers No Preference Expected Period of Homestay From_________ To_____________ Total _________ weeks

PARTICIPATION AGREEMENT FOR WORK EXPERIENCE PROGRAM PARTICIPANTS MUST READ THE FOLLOWING TERMS AND INDICATE ACCEPTANCE BY SIGNING THIS FORM. To provide accurate information in the application form, and to understand that any false or misleading information may cause immediate withdrawal from the Program. To not take part in illegal activities. To accept the placement arrangements made by the host site and to carry out assigned responsibilities to the best of his/her ability. To follow and obey all laws of Canada To provide evidence of possession of round-trip transportation to and from Canada, or sufficient funds to purchase return trip upon entry into Canada. The application must be accompanied with the following documents: Two passport photographs Copy of International Passport Updated Resume/CV Letter to hostfamily Any other additional documentation required by the Program

Refund and Cancellation Fee $375.00 CAD of initial application fee is non-refundable for all cancellations before arrival including visa cancellations Full refund of the Program fee less the initial application fee will be given if Immigration Canada does not approve a study permit. and a work permit. To obtain the refund, a request in writing must include the letter of refusal from Canadian Immigration. Refund would be made in 30 business days after getting a request and invoice for refund from students Agent. No refund will be granted to a student who is dismissed from the program due to a breach of law, policy or regulation as determined by the Government of Canada, the Police, Global Community College and/or ISCC. If a student terminates his/her participation in the WEP after arrival there is no refund. I have read and agree to the terms and conditions and attest to the accuracy of all information provided. Participants Signature: ___________________________________________________________ Date: __________________________ Signature of Parent: _____________________________________________________________ (If participant is under 21 years of age) Date: __________________________