Summer Plans - Upper Grand - International Student Program

Student Name (In English) *

Date Of Birth *

Current School *

Are you staying in Canada this summer? *

If No, please let us know your departure date and then skip to submit below

If Yes, please provide your "Host Name" along with the following information

Host Address

Host Phone Number

Student Phone Number

Email you'd prefer us to use this summer

Insurance Provider

Insurance Expiry Date