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

Residence Clubs

Vantaggio
Cosmo
closing June 15th

shared room / private bath (lower floors)	single room / private bath (lower floors)
shared room / private bath (upper floors)	single room / private bath (upper floors)

Vantaggio
Garland

opening June 15th

standard shared room / pvt bath	standard shared room / pvt bath [1 king bed, dbl occupancy]
deluxe shared room / pvt bath (kitchenette)	deluxe shared room / pvt bath (kitchenette) [1 king bed, dbl occupancy]
standard single room / pvt bath
deluxe single room / pvt bath (kitchenette)

Vantaggio
Abigail

opening June 15th

shared room / private bath	shared room / private bath [1 king bed, dbl occupancy]
single room / private bath

Vantaggio
Jefferson Square

medium shared room / private bath	small single room / private bath
large shared room / private bath	medium single room / private bath
	large single room / private bath
medium triple room / private bath

The Ansonia

shared room / shared bath	single room / shared bath
shared room / private bath	single room / private bath

The Kenmore

shared room / hall bath	single room / hall bath
shared room / shared bath	single room / private bath
shared room / private bath

Homestay

select type
of homestay:

Economy Full (shared room / shared bath)	Economy B&B (shared room / shared bath)
Standard Full (single room / shared bath)	Standard B&B (single room / shared bath)
Executive Full (sgl room / pvt bath)	Executive B&B (single 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

2013 ONLINE ENROLLMENT FORM

Personal Information

Course Information

Home Address

Address in U.S. (if known)

Visa Information

Housing Information

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