ENGLISH FOR ACADEMIC PURPOSES

APPLICATION FORM
PERSONAL INFORMATION:
Family (Last) Name: __________________________First Name: ______________________________
Date of Birth: Day ____ Month ____ Year ____ Age: ____Gender: Male o Female o
Address: Street_______________________________________________________________________
______________________________________________________________________
City/Province_____________________________________________________________________
Country/Postal Code________________________________________________________________
Telephone:
_______________________________________Fax:______________________________________
E-mail:
___________________________________
Status in Canada: Canadian Citizen Date of Entry (if not born in Canada) Mon: ________ Year: ________
Permanent Resident
Date of Entry: Mon: ________ Year: ________
Study Permit
Date of Entry: Mon: ________ Year: ________
Visitor
Date of entry: Mon: ________ Year: ________

For which session do you wish to register? (check all that apply)
Winter Session (5 January 3 April, 2015)
o
Spring Session (27 April 24 July, 2015)
o
Fall Session (8 September - 5 December, 2014)
o
ACCOMMODATION ARRANGEMENTS:
What accommodation arrangements do you require?
University Residence
Student will make Private Arrangements

o
o

If you require University Residence, please answer the following questions:

Do you want a roommate?
Yes
o
No
o
Do you smoke?
Yes
o
No
o
Do you have allergies?
Yes
o
No
o
If Yes, please explain:
______________________________________________________________
Will you require airport pick-up service?

Yes

No

ENGLISH BACKGROUND:
What is your primary language? : __________________________________________________
How many years of English instruction have you had? ___________
A language proficiency test score enables appropriate program planning and student placement. Students are required to
submit proof of a score achieved on one of these accepted measures: TOEFL, IELTS, Melab, or CAEL.
Have you studied anywhere else in Canada? _________ Name of school:____________________________
Do you plan to study at BU after successfully completing the EAP program? Yes o

EMERGENCY CONTACT
Name _____________________________________

No o

Relationship: Parent o Guardian o Next of kin o

Address:_________________________________________________________________________________
Email: ____________________________ Phone: _________________ Fax:__________________________

FEES AND DEPOSITS:

Please be advised that all application fees and deposits are fully non-refundable.
Please ensure that appropriate payment accompanies this application.
EAP Deposit
University Residence Application Fee (if applicable)
Airport Pick-up Service Fee (if applicable)
Document Courier Fee (if applicable)

C$300.00
C$ 50.00
C$ 50.00
C$ 75.00

o
o
o
o

METHODS OF PAYMENT: cheque, money order, bank transfer, credit card and cash (in person only).
All cheques and money orders must be in Canadian funds and made payable to BRANDONUNIVERSITY.
Bank transfer information: Canadian Imperial Bank of Commerce,
803 Rosser Ave.,
Brandon, MB R7A OL1, 204-726-3000
Account number: 010 18-11118
Transit Code: 00067.
Please add an additional C$10.00 when sending funds via bank transfer to cover bank-handling charges.
Credit card: Visa oMastercardo Credit card number _________________ Expiry date: ____________
I hereby authorize the English for Academic Purposes program to debit my credit card for the following
Amount: C$________________________

__________________________________________
Signature

Mail, fax or email application to:

Office of International Activities
BrandonUniversity
270-18th Street
Brandon, MB, CanadaR7A 6A9
fax: 204-727-7471 or email: allan@brandonu.ca
website: www.brandonu.ca/eap
Please Note:

Students must be 18 years or older at the start of the Program.

International students must meet Canadian Immigration requirements.
BrandonUniversity reserves the right to cancel courses due to lack of enrolment.

Tuition fees are non-refundable. If a study permit application is refused and full payment has been
made, tuition (less the deposit) can be refunded upon receipt of the visa refusal letter and the original
letter of acceptance.
This personal information is being collected under the authority of the Brandon University Act, and The
Freedom of Information and Protection of Privacy Act and will be used solely for admission to the EAP
program. If you have any questions about the collection, contact Anita Allan, Coordinator, Office of
International Activities, 727-7479