If you have any questions, please feel free to contact us at bpolan@seiq.com.  Or call us at 1-514-217-7369.

PERSONAL INFORMATION   (PLEASE PRINT IN ENGLISH)
First Name: Last Name:
Date of Birth: (Day/Month/Year) Country of Citizenship:
Gender: Male  Female
Address:
City: Phone Number:
Province: Fax Number:
Country: Email:
Postal Code:
EMERGENCY CONTACT #1 EMERGENCY CONTACT #2
Name: Name:
Phone Number: Phone Number:
Relationship: Relationship:
STATUS IN CANADA
International Student?: Yes  No Study Permit?: Yes  No  N/A
Level of English? Beginner  High Beginner  Intermediate  High Intermediate
When do you arrive in Montreal?  
STUDY PROGRAM
How long do you wish to attend high school in Montreal: 1 academic year (10 months) 6 months
What grade have you completed by time of registration:
What grade do you wish to attend when you arrive in Montreal area:
Do you need assistance in finding accomodation in Montreal: Yes  No
Do you wish to use SEIQ's pick up airport service ($75): Yes  No
(Note: some groups have this fee as part of their registration package – discuss with your representative.)

By submitting this form I confirm that I have read and accepted the General Terms and Conditions,
the Cancellation and Refund Policy, and the release agreement.