Heartland 2021 Safe Study Plan Package Application

Last (Family) Name:

First Name:

Gender:
MaleFemalePrefer not to disclose

Email Address :

Address:

City:

Province/State:

County:

Postal Code:

Telephone:

Citizenship:

Birthday (yyyy/mm/dd):

What is your current level of English?
BeginnerLow IntermediateIntermediateHigh IntermediateAdvanced

Which Full-time course are you applying for?
Intensive (Full-time, 25 hours)Pathway (Full-time, 25 hours)

If you are interested in applying to a Pathway Program, please select the College or University you are applying to:
NoneAssiniboine Community College (ACC)ATC (Louis Riel School Division Arts & Technology Centre)Conestoga CollegeEvergreen CollegeGeorgianInternational College of Manitoba (ICM)Lakeland CollegeLambton CollegeManitoba Institute of Trades and Technology (MITT)PACE at The University of WinnipegProvidence College UniversityRobertson CollegeSheridan CollegeSt Lawrence CollegeSteinbach Bible College

When do you wish to begin?
---February 8March 15April 19May 25June 28

How many weeks will you study for? The minimum number of weeks for the Heartland 2021 Study Plan is 25 weeks.

How did you hear about Heartland?
---InternetAgentFriendEducation FairEdvisor

If you applied with an Agent, please provide the following information:
Agency Company:

Agent's full name:

Agent's email address:

Quarantine Plan

All students are required to present a quarantine plan in order to meet the requirements for successful travel. Students can plan and book their own quarantine plan or choose to have Heartland plan the 14 day quarantine for them. Please indicate your preference:
I will make my own quarantine planI would like a Heartland quarantine plan

Please read through the Heartland COVID-19 Guidelines

Homestay Accommodation Information

After a student as completed their 14 day quarantine, students in the 2021 Study Plan Package will be staying in a Heartland homestay.

Please answer the following:

Any Medical Conditions?

Any allergies?

Do you smoke?
yesno

Would you live with a family that:

has children?
yesnodoesn't matter

has pets?
yesnodoesn't matter

smokes?
yesnodoesn't matter

has another international student?
yesnodoesn't matter

What are your hobbies?

Do you need airport pick-up?
yesno

Flight Information:

Arrival date: (yyyy/mm/dd)

Arrival time:

Airline & Flight Number:

Mandatory Health Insurance (included in the package price) is provided by Guard.me Insurance which includes special COVID-19 coverage.

I have reviewed the information entered above and agree that it is accurate and correct.

FEES ARE SUBJECT TO CHANGE, UNLESS PAID IN ADVANCE. ALL FEES SHOULD BE PAID DIRECTLY TO THE SCHOOL. HEARTLAND INTERNATIONAL ENGLISH SCHOOL ASSUMES NO RESPONSIBILITY FOR MONEY PAID TO COMPANIES OR INDIVIDUALS CLAIMING TO REPRESENT THE SCHOOL.

- HEARTLAND INTERNATIONAL ENGLISH SCHOOL WILL NOT BE LIABLE IN ANY WAY TO THE STUDENT FOR LOSS, DAMAGE, OR INJURY TO PERSONS OR PROPERTY HOWSOEVER CAUSED.

- ALL FEES ARE IN CANADIAN DOLLARS.

I ACKNOWLEDGE THAT I AM FULLY RESPONSIBLE FOR MY OWN MEDICAL INSURANCE. I HAVE READ, UNDERSTOOD AND AGREE TO COMPLY WITH SCHOOL POLICY REGARDING TUITION FEES AND REFUNDS. IF I BECOME ILL OR INCAPACITATED, HEARTLAND INTERNATIONAL ENGLISH SCHOOL AND ITS EMPLOYEES MAY TAKE ANY REASONABLE ACTION THEY DEEM NECESSARY FOR MY OWN SAFETY AND WELL-BEING.

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