12-Week Intensive English Program Application

Before filling out this form, please take some time to familiarize yourself with the admission requirements, refund policies and other associated program information on our program information page.

Name

Family Name
Given Name

Address:

Street
City
Province/State
Country
Postal Code / ZIP

Contact Information

Phone
Fax
Email

Personal Info

Sex	Male Female
Date of Birth	Day Month Year
Country of Birth
Nationality / Citizenship

Education / Work

Are you also applying for Provisional Admission to a degree program at Memorial University? (Please make a separate application.)	Yes No
Last year of education completed
Field of study
Occupation
If you are planning future studies, please specify the field
Previous studies in English (type and duration)
Result of English tests such as TOEFL, IELTS or other if available
Estimate of English level

Program Semester

Semester

Agency Contact Information (if applicable)

Agency Name
Agency Address
Contact Person

Application Fees

12-Week Intensive English Program with orientation and testing. Tuition for program is $3500 CAD.

Please forward $150 CAD application fee
Fees should be made payable to "ESL Programs, Memorial University"
A $400 deposit on tuition is required by 4 weeks prior to the start of classes to confirm registration. This deposit is refundable if a request is made before 4 weeks prior to the start of classes.

Acceptable methods of payment:

Wire Transfer

Credit Card (Visa or MasterCard)

If forwarding fees by regular mail, please send to:

ESL Programs
SP3019 Spencer Hall
Memorial University
St. John's, NL
Canada
A1C 5S7

For Wire Transfer or Credit Card payments, please e-mail us for instructions. It is possible to fax credit card payments to (709) 864-8282. Do not send credit card numbers via email - it is not secure.

Important - Please Read

By submitting this form I agree that I have read and understood the refund policy and admissions requirements on this website. I understand that the 12-Week Intensive English Program is designed for intermediate to advanced students, at or above TOEFL 430 or the equivalent on other standard tests.

For further information please contact:

English as a Second Language Programs
Memorial University of Newfoundland

Spencer Hall SP-3019
St. John's, NF
Canada
A1C 5S7

Fax: (709) 864-8282
Phone: (709) 864-8740
Email: esl@mun.ca