A.L.I Academie Linguistic International

a) Identification

First Name * Family Name *

Father's Last Name Mother's Last Name

Date of Birth *

Gender * Male Female Occupation

Nationality Native Language

b) Address

Street Address *

City * Province / State *

Country * Postal Code / Zip *

Telephone * Fax

Email address *

c) Emergency Contact - person we can contact in case of emergency

First Name Family Name

Telephone Fax

Email address

d) Where did you hear about A.L.I.?

Study Abroad Agent - please specify Agency name :
Internet - Study Abroad Web Site - please specify name:
Educational Fair - please specify name:
Friend / Former Student - please specify name:
Returning Student
Internet - Search Engine
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Language : *

I will be studying English in Montreal

I will be studying French in Montreal

Due to high demand, it is always best to begin on a recommended start date, whenever possible. A.L.I. is open all year round. We accept students every Monday, except in the last week of a session. If you would like to start on the 2nd or 3rd Monday of a session, you may be placed in an ongoing class. Official start dates are marked in black circles on the calendar.

Start Date (mm/dd/yyyy) for ---Please Select--- 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks 7 weeks 8 weeks 9 weeks 10 weeks 11 weeks 12 weeks 13 weeks 14 weeks 15 weeks 16 weeks 17 weeks 18 weeks 19 weeks 20 weeks 21 weeks 22 weeks 23 weeks 24 weeks 25 weeks 26 weeks 27 weeks 28 weeks 29 weeks 30 weeks 31 weeks 32 weeks 33 weeks 34 weeks 35 weeks 36 weeks 37 weeks 38 weeks 39 weeks 40 weeks 41 weeks 42 weeks 43 weeks 44 weeks 45 weeks 46 weeks 47 weeks 48 weeks 49 weeks 50 weeks 51 weeks 52 weeks

Please select a program :
Basic Program 20 Hours / Week
Intensive Program 25 Hours / Week
Super-Intensive Program 25 hrs / Week + 5 Hrs / Week semi-private

Please indicate your current level in the language of study? :
Beginner
Intermediate
Advanced

Have you completed A.L.I.'s written placement test? :
Yes
No

Type of accommodation ---Please Select--- Homestay - 2 meals / day Homestay - 3 meals / day Residence - no meals

Do you require medical insurance coverage during your stay in Canada? :
Yes No (All students must have some form of medical coverage while studying at ALI)

First Day of Medical Coverage Last Day of Medical Coverage

Do you require (Airport) Pick-Up service? : Yes No

a) Important Information

• A.L.I. Accepts payments in $US or $CDN
• All credit card payments will be billed in $CDN only
• Prices subject to change without notice

b) Payment Information

Payment made in * : $ US $ CDN

Payment * : $

Payment type: Credit Card International money order Traveler's checks Bank wire transfer

I have read and I agree to comply with A.L.I.'s refund policy *