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Pre-Registration Form Student Information Mr. Ms. Family Name : First Name : Date of Birth : ID Type : PR Card BC ID Passport Other ID Number : Citizenship : First Language : What other lnguages do you speak ? Street Address City : State/Province : Country : Postal Code : Phone Number : Fax Number : Email Address : Emergency Contact Name : Relationship : Telephone Number : Course/Program Information (Please check desired programs and/or courses ) ESL Drawing Photography IELTS Painting Fashion design TOEFL Art History Interior Design Business English Sculpture Graphic Design Piano Photoshop Guitar Office Tools Violin Computer Programming Voice Other : Interest in certificate program Target Start Date : (MM/YYYY) Duration of Study : weeks Self-Assessed Language Level : Beginner Higher Intermediate Intermediate Advanced Hobbies and Interests I learned about Pera College through Internet Education Fair Friend / Family Newspaper Ad Agency Others