Canadian English Academy Registration Form

Please completely fill out this form then click the 'Submit' button at the bottom of the page. The results will then be emailed to the Canadian English Academy.

Date of Registration:
First Name:
Family or Surname:
Address:
City:
Province:
Postal Code
Phone Number:
Fax Number:
Email Address:
Contact Information in Canada: (a friend, neighbor or relative)
Relationship:
Phone Number:

I have taken ESL classes before.
If so, when? Where? For how long?:
First Language:
Country of Birth:

I would like to take ESL classes:
Full Time  Part Time   Daytime  Evening
I probably need this level of English:
Beginner  Intermediate   High Intermediate  Advanced
My strengths are in:
Reading  Writing  Speaking
I need the most help in:
Reading  Writing  Speaking
I am presently taking other classes
If so, what is the name of the course or program?:
I would like to start English classes: (date)
I heard about the Canadian English Academy from:
A Friend  A Classmate   A Brochure  A Poster
An Advisor  An Instructor   The CEA Website
Other:


Please Press the 'Submit' button only once.

  
©2003 Canadian English Academy