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Personal Information (Please Print Clearly) First name ______________________________________________________ Middle name ____________________________________________________ Family name ____________________________________________________ B irt h day: __ __ __ __ __ __ __(dd/mm/yyy y) G ende r: Male Female Nationality ______________________________________________________ City of Birth First Language ___________________________________________________ Passport Number Visa type you will study on: Student Visa Visitor Visa Working Holiday Visa Visa Waiver Other Do you require a custodial letter? Yes No Yes + Notarized Address in Home Country: Street _________________________________________________________ City Province/Stat e ______________________ Postal Code __________________ Country ________________________________________________________ Telephone _________________________ Emergency No Fax ______________________________ ______ ______ ______ ______ _____ Email Do you hav e a ny phy sical or mental health pro blems ? Yes No If yes, give d etails: ________________________________________________ Immediate Contact (if dierent from home address) Street _________________________________________________________ City ___________________________________________________________ Province/Stat e ______________________ Postal Code __________________ Country ________________________________________________________ Telephone _________________________ Emergency No ________________ Fax ______________________________ Email Which Location: Vancouver Victoria Toronto Calgary Hawaii How did you nd out about Global Village? Agent Friend Advert eb site ther Please specify: ___________________________________________________ Courses (Contact school for course availability) English speaking ability Low Medium High Very high eneral English Business English Academic Year Semester Gap ambridge Preparation FCE AE PE Jumpstart Cambridge V Pathways FIC ICM Humber Teacher Training English Plus _______________________________ ambridge/I ELTS Support TOEIC Preparation TOEFL Preparation IELTS Preparation Work Experience Summer Teen Activity Private Lessons Special requests? ___________________________ Lessons / week _______________________________ Intended Period of Study # of weeks ___________________________________ Start Date ___________________________________ (dd/mm/yy) End Date ___________________________________(dd/mm/yy) Accommodation Accommodation required? Yes No Type of accommodation requested? Homestay Apartment Residence For accommodation options other than homestay, please contact the school. Do you have any allergies? Yes No Do you have special diet requirements? If yes, give details: Yes No Do you smoke? Yes No Will you live with a family with: Smokers Dogs ats Young Children Yes Yes Yes Yes No No No No What are your interests? Placement Preference Please list your order of preference from 1 to 3 (1 is your rst choice). Family w/children Family w/teenagers Family w/o children It does not matter ________ GV cannot guarantee your rst choice. Choice Where available. Check fee schedule. Full Board Half Board Room Stay Single Room Expected Period of Homestay # of Weeks Arriving: Departing: _________ (dd/mm/ yy) _________ (dd/mm/ yy) Emergency Contact Person Name: Telephone Number: Flight Details Airline & Flight # rrival Date Arrival Time _________ (dd/mm/yy) _________ (dd/mm/ yy) Airport Transfer One way Two way None Required or other accommodation options (apartments, hostels, guest houses, student house, esidence) contact schools directly for availability. Declaration I have read and agree to be bound by the General Conditions and the Cancellation and Refund Policy Name (Print)___________________________________________________ Signature: ____________________________________________________ (Signature of applicant, or parent if applicant is under age) Method of Payment Bank transfer Bank draft Cash Bank cheque VISA Mastercard ther Card Number __________________________________ Expiry _______ Amount ___ ___ ___ ___________________________ __ USD CAD Card Holder Signature __________________________________________ Please e-mail or fax registration forms to: V Hawaii [email protected] 1 808 943 6400 V Vancouver [email protected] 1 604 684 2124 V Toronto [email protected] 1 416 968 6667 V Calgary [email protected] 1 403 543 7309 V Victoria [email protected] 1 250 384 2123 8 GV Registration Form or apply online at http://gvenglish.com/english/apply/index.cfm P rint Form S ubmit by E mail Ope n Hea rts Int'l E ducation- ht tp :// www.ohglob al. com

Global Village Application Form for Canada and USA

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9Refund Policies ‒ CanadaGV Vancouver, Victoria, Calgary and Toronto

The registration fee is non-refundable at all times. TheHomestay placement fee is non-refundable except inthe case as outlined in the Homestay Refund Policybelow.

To apply for a tuition refund, the student or agent mustsubmit a written notice of withdrawal.

There are no refunds for classes missed due to holiday,graduation, orientation, and / or other situationsbeyond the schools control.

In this policy, the word program refers to the full cycleof studies to which the student registered.

Effective before the start date1.

If a student cancels 30 days or more before the1.1

start of the program, the school will retain 25%of the fees due under the contract and refund75% of the fees to the student.

If a student cancels less than 30 days before the1.2start of the program, the school will retain 40%of the fees due under the contract and refund60% of the fees to the student.

If a students permit application is rejected,1.3the school will refund 100% of the total tuitionees and Homestay, except Registration and

Homestay Placement Fees.

Effective after the start date2.If a student cancels (or is dismissed) within 52.1calendar days of the start date of the program,the school will return 50% of all tuition fees

aid under the contract.

No refund will be paid if a student cancels (or2.2is dismissed) when more than 5 days of the

rogram have been completed.

Refunds on postponed starting dates are2.3

based on the original start dates (applies alsoto students transferring from one GV school toanother).

Homestay Refund Policy

If written cancellation notice is given 12 weeks or3.

more before beginning of homestay, all money willbe refunded including Homestay Placement Fee.

f written cancellation notice is given less than 124.eeks before beginning of homestay, all money wille refunded except for the Homestay Placementee.

For refund requests after commencement of 5.Homestay:

The student should inform the GV Homestay5.1Offi ce in writing three weeks before the endof the homestay period if he/she decides to

terminate the agreed homestay period. If thenotification period is less than 3 weeks, thenin addition to the non-refundable notificationperiod, a $150 cancellation fee will apply.

If the host family has failed to meet the5.2Homestay conditions, the student will bemoved to another Homestay, and there willbe no refund given for the period of homestayalready used.

Work Experience Refund Policy ‒6.http://gvenglish.com/content/en/programs/2009_

GVCan_WEDrefund.pdf 

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10

nited States ‒ GV Hawaii

To be considered for a refund, a student must1.submit a completed Cancellation Form to theschool at least 24 hours before the beginning of the cancellation period. The date of receipt of thewritten notice will determine the amount, if any, to

be refunded.

There are no refunds on security deposits for2.apartment and dormitory if students cancel theseaccommodation bookings before or after arrival.There are also no refunds for the Kaimuki andKapiolani residences once the room is confirmed forthe student.

There is a $80 Accommodation & Program3.Cancellation/Reduction fee. If you came through anagency, there may also be other fees assessed. GVHawaii will check with your agency and let you know

of any other fees that may be assessed.

For Teenage Activity Programs and other specialized4.Activity Programs [e.g. Study tours, English Plus,etc.], there are no refunds for homestays, activities,airport transfers, or excursions, but only for tuitionthat is offered as per the normal Withdrawal/Cancellation policy [see below].

Students who are absent from class for 105.consecutive days will have their enrollmentscancelled on the 10th day of absence. Refunds willbe prorated from their 1st day of class after their

cancellation, except if it occurs after the no-refunddate. Any money to be refunded will be mailed tostudents home address or to their travel agent.

Students who take a Leave of Absence during the6.term will not receive any refund for the period of theLeave of Absence.

There are no refunds for classes missed due to7.holidays, graduation, orientation, acts of god and/or other situations beyond the schools control.

If a student is dismissed from school for any reason,8.

refunds will be calculated from the date of theirdismissal as per the normal Withdrawal/Cancellationpolicy [see below]. Any money to be refunded willbe mailed to the students home address or to theirtravel agent.

It is understood that students who register through9.travel agents have signed contracts with theseagents that may include cancellation penalties,no-refund policies, or home country-refunds-only conditions. In all cases regarding agent-sentstudents, GV Hawaii will confirm the conditions of agent-student contracts with travel agents beforeissuing any refunds.

Refund Policies ‒ United StatesThere is NO accommodations refund once the10.student begins his/her accommodations unlessthe school or accommodations provider/homestayamily violates the accommodations service

conditions. If the host family has failed to meetomestay conditions, then the Accommodations

Coordinator must be notified and given a chance to

ediate and/or correct the problems. Only after theAccommodations Coordinators intervention, andf the problems persist, the student will be moved

to another homestay, and there will be no refundgiven for the period of homestay already used.Only if no replacement homestay can be foundwill an accommodation refund be issued. Students

ust request to cancel future accommodations(homestay and apartment) 3 weeks in advance withthe Accommodations Coordinator. Cancellations

ade less than 3 weeks in advance may be subjectto penalty fees comprising part or all the unused

accommodations amount.

Textbook fees will not be refunded once the books11.have been issued to the student.

efunds are issued 30 days after the written request12.date. If you came through an agency, they mayhave other restrictions or fees. GV Hawaii willcontact your agency and let you know of any otherconditions.

Cancellation/Withdrawal be ore the start date.13. If a student cancels before the start date, GV Hawaii

will refund all monies paid less the registration fee,accommodation placement fees, and deposits.owever, if a student cancels within 72 hours of aking the registration, GV Hawaii will refund ALLonies paid less non-refundable accommodation

deposits.

Students Denied Visa/Entry.. A student denied astudent visa or entry into the United States will

e given a full refund of all monies paid less non-efundable accommodation deposits and SEVISelated fees, if applicable.

Withdrawal/Cancellation o Enrollment a ter the. start date. If a student withdraws from school anddoes not plan to return to GV Hawaii, the student

ust notify GV Hawaii by completing a Cancellationorm. If a student does not notify the school thate or she is withdrawing, GV Hawaii will check

attendance records and if the student has beenabsent for more than 10 consecutive class sessions,he or she will be dropped from the enrollment. GV

awaii will calculate the students refund basedon the last day of attendance or the Mondayollowing their 10th consecutive day of absence.

There are no partial week refunds. In all cases a $80Accommodation & Program Cancellation/Reduction

ee is applied.

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GV General Conditions 11

Application Process: A letter of acceptance will beissued upon receipt of the completed registrationform and a payment. Please check with the school onpayment policy. The original copy may be mailed, faxed,or emailed upon request. The school is not responsiblefor any extra courier charges.

Minors: Students under the age of 18 (under 19 inVictoria + Vancouver) must have their applicationco-signed by a parent or legal guardian. Underagestudents must submit underage agreements signedby their parents. Custodianship may also need to bearranged.

Payment: Students may be required to pre-pay tuitionfees when applying for student visas. Check with schooland local consulate or embassy on payment methodsand any other requirements. Payment may be madeby credit card, wire transfer, money order, or bank draft.

dditional bank charges may also apply. Student visasmay take two months or more to process.

Refunds: Check fee sheets and our website forindividual school policies. To be considered for a refunda student must submit a written notice of withdrawalto the school. The date of receipt of the written noticedetermines which cancellation charges will be applied.Refunds will be issued within 30 days of receipt of thenot ce.

Changes and availability: Start dates, programs andcourse content may change at any time and withoutprior notice. The fees, dates and conditions listed inthis brochure are subject to change at any time andwithout prior notice. All courses are available based onenrollment.

Responsibility: Global Village and its member schoolsaccept no responsibility whatsoever for any loss ordamage to the personal belongings or property of astudent or program participant or for any injury to ordeath of a student or program participant occurring onor off school property.

Students must comply with the rules of the school.Failure to do so may result in dismissal. Please contactthe school for refunds in case of dismissal.

Directors must receive a written description of allcomplaints. Please check with the school regarding acomplaint resolution procedure.

Medical insurance: Suffi cient medical insurancemust be obtained before arrival. $500,000 minimumcoverage strongly recommended.

Global Village English Centres do not take responsibilityfor any misinformation found in third party materials.

In this policy, the word program refers to the fullcycle of studies to which the student registered.Extensions of study will be treated separately.The following calculation is made for tuition andspecialized programs:

For programs of 12 weeks or less, if a student15.a cancels (or is dismissed) within 5 calendar daysof the start date of the program, the schoolwill return 50% of all tuition fees paid underthe contract. There are no refunds beyond thisperiod.

For programs of 13 weeks or more, if a student15.bcancels (or is dismissed) within 20 calendardays of the start date of the program, theschool will return 50% of all tuition fees paidunder the contract. There are no refundsbeyond this period.

Transferring to GV Hawaii.16. bonafide non-immigrant student enrolled as a full-time F-1student may transfer to GV Hawaii. All GV Hawaiiadmissions procedures must be completed. Inaddition, transfer applicants must:

Notify current school of intent to transfer.16.a

Have current school complete GV Hawaiis16.bVerification of Enrollment form.

Submit a copy of current I-20 (full-time16.cstudents), passport, I-94 card and completedGV transfer form to GV Hawaii.

Transferring to Another School.17. If you would like totransfer to another school, please talk to the studentservices manager to complete the appropriateforms. You may also need to have GV Hawaiicomplete forms from your new school (talk to yournew school to see if any forms are needed).