Online Enrollment Form

* family name

* first name

country of birth

citizenship

date of birth


genderder female dmale
e-mailde

street

city

postal code

country

phone

fax

street

city

postal code

phone

fax

Will you apply for an F-1 student visa? yes no

Would you like us to arrange housing for you? yes no

course
start date
course length	d

check-in
check-out

Vantaggio
Cosmo

dbl room / pvt bath (lower floors)	sgl room / pvt bath (lower floors)
dbl room / pvt bath (upper floors)	sgl room / pvt bath (upper floors)

Vantaggio
Union
Square

dbl room / hall shower	sgl room / hall shower
dbl room / pvt bath	sgl room / share bath
	sgl room / pvt bath

Vantaggio
Jefferson
Square

medium dbl room / pvt bath	small sgl room / pvt bath
large dbl room / pvt bath	medium sgl room / pvt bath
	large sgl room / pvt bath
SPECIAL OFFER medium triple room / pvt bath

The Ansonia

dbl room / share bath	sgl room / share bath
dbl room / pvt bath	sgl room / pvt bath

select type
of homestay:

Standard Full (sgl room / share bath) << most popular

Economy B&B (dbl room / share bath)

Standard B&B (sgl room / share bath)

Executive B&B (sgl room / pvt bath)

Economy Full (dbl room / share bath)

Executive Full (sgl room / pvt bath)

Do you smoke?

yes no

Do have allergies?

yes no

Family with children ok?

yes no, I prefer a family without children

Family with pets ok?

yes no, I prefer a family without pets

List your hobbies:

Describe your expectations:

Will you like to book the aiport pick-up service? one-way round-trip no pick-up service needed

2010 ONLINE ENROLLMENT FORM

Personal Information

Course Information

Home Address

Address in U.S. (if known)

Visa Information

Housing Information

Residence Clubs

Homestay

Airport Pick-up Service

I have my own insurance coverage and will provide proof upon arrival.
I wish to purchase travel & health insurance through Brandon College.

Health & Travel Insurance (only mandatory for all students with an F-1 visa!)

Online Special Code:

Did any of our Representatives or Agencies in your country help you?

agency name:

Comments / Questions

Enrollment Agreement

Student Signature (please type your full name):
date signed:

* as it appears in your passport!

coverage start
length	weeks

This agreement is a legally binding instrument when signed by you and accepted by the school. I have read and understood, and agree to the terms and conditions, the refund and cancellation policy, course schedules, rates, and starting dates. I hereby affirm that I have sufficient funds to pay for all course costs, as well as the cost of food, accommodation and all other personal expenses during the full period of my course at Brandon College. In case of illness or injury, I grant permission to be examined or treated as necessary. Any questions concerning the school that have not been satisfactory answered or resolved by the school should be directed to the student’s consulate, the U.S. Department of Homeland Security, or the Bureau for Private Postsecondary and Vocational Education in the Department of Consumer Affairs, State of California; 400 R Street, 5th Floor, Sacramento, CA 95814, phone (916) 445-3427.

Emergency Contact (Who should we notify in case of emergency? Please list a relative, friend, husband, wife, etc.)

phone

name