Confidential Application
for Registration
FIELD STUDIES PROGRAM
NAME AND DATES OF TOUR:
TOUR TERM: LIST CREDIT COURSE(S)
FULL LEGAL NAME: GENDER: MALE FEMALE
CURRENT ADDRESS:
POSTAL CODE:
PHONE (HOME): PHONE (CELL):
PHONE (WORK):
DATE OF BIRTH (DD/MM/YY): EMAIL:
HAVE YOU HAD AND TRAVEL EXPERIENCE OUTSIDE OF CANADA? YES NO
IF YES, WHERE & WHEN HAVE YOU TRAVELED?
TELL US WHY YOU WANT TO BE PART OF THIS FIELD STUDY
HOW DID YOU HEAR ABOUT THIS PROGRAM?
Signature of Applicant Date of Application
I understand that:
• Field Study Program fees and itineraries are subject to change. A minimum number
of particiants is required for the program to proceed. Participants are responsible
for ensuring that they have the appropriate travel documentation (i.e. visas, valid
passports, etc.), personal insurance, and vaccinations.
• Any deposits/program fees are non-refundable. Refunds will only be made if the Field
Study is cancelled by Langara College.
• While submiing this application form and deposit indicates my interest in
participating in this Field Study Program, it does not guarantee me a spot in the Field
Study or any of the related credit course(s). My participation in this Field Study is
subject to approval by the Field Studies Coordinator.
To complete this application, please
include a deposit cheque of $ 500
made payable to Langara College
Payments can be made by cheque, using
the drop-off box (under counter), debit
card, or cash at Langara College Financial
Services (Room B231, Monday - Friday,
10:30 am - 3:30 pm).
Final payment due by March 15, 2019.
EMAIL APPLICATION TO:
jjansen@langara.ca
MAIL APPLICATION TO:
Janinah Jansen
Coordinator, Educational Travel Program
Langara College Continuing Studies
Unit L9 - 601 West Broadway,
Vancouver BC V5Y 4C2
FAX APPLICATION TO:
604.323.5899 An: Janinah Jansen
* Registration deadline February 28, 2019.*
STUDENT ID:
DEPARTMENT:
(as shown on passport)
