Application Date*
(Format: MM/DD/YYYY)
Student Type*
Family Name*
First Name*
Gender*
Birth Date*
(Format: MM/DD/YYYY)
Passport Number*
Passport Expiry*
(Format: MM/DD/YYYY)
Fathers Name*
Mothers Name*
Mothers Family Name Before Marriage*
Parental Accomodation*
Home Street Address*
Home Community*
Home Province*
Home Country*
Home Postal Code*
Home Phone*
Home E-Mail*
Primary Contact*
Health Conditions*
Allergy Status*
Health Comments*
Special Needs*
Disability Support*
Arrival Date*
(Format: MM/DD/YYYY)
Departure Date*
(Format: MM/DD/YYYY)
School Year*
First School Choice*
Second School Choice*
Semester Request*
Spoken Language At Home*
Language Assistance?*
Language Instruction Home Country*
Custodian Name
Custodian Country
Custodian Province
Custodian Community
Custodian Street
Custodian Postal Code
Custodian Phone
Custodian E-Mail
Broker Agency
Broker Name
Broker Country
Broker Province
Broker Community
Broker Street
Broker Postal Code
Broker Phone
Broker E-Mail

CONDITIONS & AGREEMENTS
1. The student must obey the laws of Canada and the Province of New Brunswick, rules, and polices of Anglophone West School District and the school which they attend.
2. The student or AEI must immediately inform the school of any change in address and/or Homestay.
3. The student must maintain a FULL time timetable.
4. Anglophone West School District will place students in an age appropriate grade level.
5. Anglophone West School District will have the right to place the student in a school that serves the neighbourhood in which the student lives.
6. Anglophone West School District will have the sole discretion in placing students in courses which includes English as an Additional (EAL) as it deems appropriate.
7. Anglophone West School District may require students to undergo a Language Placement test to determine the need for EAL support.
8. Participating in school and International activities and outings may result in random pictures of the student for promotional purposes or to be used on district or school WebPages.
9. Anglophone West School District, from time to time, may offer to students the opportunity to take part in various Extra-Curricular activities where attendance and participation would be voluntary.
10. The purchase of medical insurance is compulsory.
11. Falsehoods or inaccuracies in the application OR failure to abide by the above conditions may result in immediate dismissal from the program and the student returned home at the expense of the parents. No refunds will be granted.
I agree to indemnify and hold harmless Anglophone West School District, its officials, officers, employees, agents, volunteers, representatives, or any of them from any claims, demands, expenses, costs(including legal fees), suits, debts, liabilities
I have read, understood, and agree to follow the conditions, releases and waivers as outlined above and hereby apply for acceptance to school for the above mentioned student in Anglophone West School District, Fredericton, New Brunswick