Pacific Coast Language Academy

Registration Form

Personal Information
Full Name : Phone : Fax:
Address : Email : Other:
Emergency contact:
Type of Visa: Visitor Student Working Holiday Other
Occupation:
 
Program and Level
English Business Spanish TOEFL/TOEIC PREP
Type of Program: Full Time Morning Part Time Afternoon Part Time
Start Date: End Date:
 
Arrival and Accommodation
Date of Arrival: Airport Reception: Yes No
Flight Information: Airline:
Flight Number: Arrival Time:
Do you want PCLA to arrange Homestay? Yes No
 
Fees Amount Due
Registration: $100
Homestay Placement : $100
Tuition: $
Homestay: $
Airport Pickup: $50
Books: $
Total Fees $
 

Tuition fee includes materials and taxes
Thirty (30) days' notice must be given for any changes.
There is a 5% administrative surcharge on all payments by credit card.
Registration over the Internet does not guarantee acceptance.

 
I have read and understand the Acceptance Policy and this Registration Form. I wish to register for studies at Pacific Coast Language Academy and agree to abide by the rules and conditions of the Pacific Coast Language Academy.
Name: Date: