Student Email *
Student Cell Phone Number *
Will There be Any Other CISS MLI Students Joining The Trip? If Yes, Please List: *
Student Country of Origin * Choose student country of origin Argentina Austria Bangaldesh Belgium Bermuda Bolivia Brazil Burundi Canada Chile China Colombia Czech Republic Denmark France Georgia Germany Hong Kong India Iran Italy Japan Malaysia Mexico Nigeria Norway Oman Peru Poland Russia Rwanda Slovakia Slovenia South Africa South Korea Spain Sweden Switzerland Taiwan Thailand Turkey Uganda Ukraine United States of America Vietnam
Canadian Province You Live In * Choose the province you live in AB BC ON QC
Canadian Community You Live In * Choose the community you live in Abbotsford Langley Surrey Airdrie Burnaby Coquitlam Greater Victoria Victoria Comox Quilicum Beach Cowichan Sooke Saanich Langley Nanaimo, Ladysmith, Gabriola Island, Duncan North Vancouver Penticton Port Coquitlam Richmond Gibsons, Sechelt Surrey Vancouver West Vancouver
Canadian Community You Live In * Choose the community you live in Calgary Coaldale Lethbridge Okotoks Red Deer
Canadian Community You Live In * Choose the community you live in Ajax Almonte Angus Barrie Bracebridge Bradford Brampton Brockville Cambridge Carleton Place Collingwood Cornwall Exeter Goderich Gravenhurst Guelph Hamilton Huntsville Innisfil Kawartha Lakes Kemptville Kincardine Kitchener KWC Lindsay Listowell London Meaford Midland Mississauga Mitchell Muskoka North Bay Orangeville Oshawa Ottawa and Area Owen Sound Peel Perth Peterborough Pickering Port Elgin Private Schools Renbridge Renfrew Russell Smith Falls St. Mary's Stratford Sudbury Thunder Bay Toronto Walkerton Waterloo Whitby Wiarton Windsor Wingham
Canadian Community You Live In * Choose the community you live in Montreal Laurentians
Please Select Your Student's Coordinator * Select your Student's Coordinator Analia Diaz Anelise Farias Cindy Froud Flor-Rita Padilla Katsumi Watanbe Linda Utas Lisa Kawalauskas Lynette Johner Mayu Kida Michelle Edis Mozhgan Zolfi Neil Reid Noriko Webb Reina Taniguchi Rina Kawasumi Sherri Kosti-Bartolomei Yuki Inoue
Please Select Your Student's Coordinator * Select your Student's Coordinator Analia Diaz Barb Oucharek Corinne Nelson Katsumi Watanbe Lisa Kawalauskas Mayu Kida Noriko Webb Reina Taniguchi Rina Kawasumi Samantha Spiegelberg Yuki Inoue
Please Select Your Student's Coordinator * Select your Student's Coordinator Analia Diaz Katsumi Watanbe Mayu Kida Noriko Webb Reina Taniguchi Rina Kawasumi Shari-Ann Fleming Yuki Inoue
Please Select Your Student's Coordinator * Select your Student's Coordinator Addie Guccino Adriene Mackenzie Analia Diaz Aneta Soszynska Anne Baxter Barbie Barta Christian Salmoral Debra Yantha Devon Crossgrove Ella Ramezani Fatima Masri Ginny(Jingy) Chen Heather McDowell Jackie Allen Jane Banks Janis Foy Jennifer Chaput Jen Gauthier Jodie Rogers Julie Pyke Katsumi Watanbe Kayla Knight Lisa Hill Lisa Metivier Lori Trelinski Marketa Galligan Mayu Kida Meenu Bhandari Matthew Dengate Nancy Shaw Noriko Webb Patie Ramnarine Paula Greaves Reina Taniguchi Rina Kawasumi Rippy Chhabra Shanice Flournoy Shauna Porter Shirley Lynch Skyler Chretien Sonia Ellis-Seguin Stephane Lavoie Tina St.Martin Tina Wilson Tracey Maranda Yuki Inoue
Email Address of Host Family Primary Contact *
Approximate Time of Departure *
Approximate Time of Return *
Will The Student Miss Any Class? * Yes No
If Yes, How Many Days Will The Student Miss? *
Please Provide The Phone Number of The Supervising Adult Listed Above. *
Where Are You Travelling To (City)? *
How Will You Get There (Drive, Train, Bus). Please Provide The Exact Details in The Trip Details Area: *
Trip Details 1) Who will be going with you (first and last names) *
Trip Details 2) What are your plans (itinerary) *
Trip Details 3) Bus, Train or plane details and any other important details including flight numbers (departing and arriving) *
Trip Details 4) Travel plans to airport and back to homestay *
Accommodation Type: * Please select Camping: Tent/ Trailer, etc Cottage / Cabin Hotel Motel Relative's home Not Applicable - it's a day trip
Is there any cost associated with this trip that the student will be responsible for? If so, please state the amount and what it is covering. If no, please enter "No" below *. *