English Summer Institute 2010

(ESL and Integrated Coastal and Ocean Management)

Application form
PLEASE PRINT CLEARLY AND ANSWER ALL QUESTIONS

A
Family name: ___________________________ Personal name:
_______________________________
Address:
____________________________________________________________________________
_______________________________________ Postal Code/Zip Code
__________________________
Telephone: _____________________________ Fax:
________________________________________
E-mail: _________________________________
Country of Birth: _________________________ Nationality/Citizenship:
________________________

Male  Female  Date of Birth: Day ____ Month

______ Year ______
Are you also applying for provisional admission to a degree program at
Memorial? Yes ___ No ___

B Last year or degree of education completed:

____________________________________________
Field of Study: ______________________________ Occupation:
______________________________
Plans for future studies (please specify in what field):
_______________________________________
Previous studies in English (type and duration):
____________________________________________
Results of English tests such as TOEFL, IELTS or other if available (please specify):
_________________
Estimate of English level:  Beginner  Elementary  Intermediate High-
intermediate  Advance

Please Select your English Program Below:

5-Week English Summer Institute 2010(ESL and Integrated Coastal and Ocean
Management)

Tuition, accommodation, some materials and field trips

$2860*
 Summer 2010 July 5 to August 6
Application Fee and Signature:

I have read and understood all the information on both sides of this application form
and I enclose my application fee of $100 CAN:

______________________________________
_____________________________________
Student Signature Date

Payment Option:
Credit Card:  Visa  Master Card Number:
_________________________________________
Expiry: ______________________

 International money order (CAN) enclosed

Age Requirement: These are programs for adults who have graduate from high
school. You must be 19 years of age to participate in the 5-Week English Summer
Institute.

Visa Requirements: Students may study in a language course in Canada that is

less than 6 months duration without a student authorization, but a visitor’s visa may
be required. Please check with your local Canadian Embassy for visa application
procedures. Students planning to extend their studies for longer than 6 months
should apply for a student authorization. Obtaining the necessary information and
visas is the responsibility of the student.

Health Insurance: Please note that students purchase MUN’s health insurance
plan once they arrive in Canada.

Policy on Refunds: If for any reason we cannot accept a student into an ESL
program, the application fee will be refunded. For students who are accepted into a
program, the application fee is non-refundable. Seventy-five percent (75%) of
tuition will be refunded to students who withdraw during the first two weeks of the
program. No refunds can be made after that time.

*Payment of Program Fees: Program fees must be paid by the FIRST day
of classes. Fees must be paid in Canadian Dollars. Program Fees are
subject to change. Please verify at time of application.

Accommodation Information for English Summer Institute program:

English Summer Institute (5-week program) students are housed in Burton’s Pond
Apartments (see information below). Housing is included in the program fees.
Other options are not generally available for this program. Students who wish to
make their own housing arrangements may receive a discount on the program fees.

Apartment-style residence: Burton’s Pond Apartments

The Burton’s Pond Apartments complex, located on the eastern end of the Memorial
University campus, houses 512 single students in four apartment buildings. One
building of 15 apartments is designated for couples or single parent students.
There are 4 single students’ buildings. Each building has 3 floors with 11 four-
bedroom apartments on each floor. Each apartment can accommodate 4 students,
each of whom has a private bedroom. Kitchen, living/dining room and bathroom are
shared. All apartments are fully furnished.

Email your application to: echo.pittman@mi.mun.ca

or fax to: 1-709-778-0371

If you have any questions, please email: echo.pittman@mi.mun.ca