Renison ELI Student Information Form | English Language Institute

Please complete the Renison ELI Student Information Form before beginning your placement test. The information in this form is to ensure that our student records are complete and up to date. All information will be kept confidential.

Your Information

Please provide your personal and contact information here.

First Name

Last Name

Renison ELI Program:

English for Academic Success (EFAS)

English for Success (EFS: classes + residence)

English for Success (EFS: classes only)

Date of Birth

Telephone number in Canada

Please list the phone number in Canada we can reach you with if there is an emergency. If you do not have a Canadian phone number, please leave this section blank and visit the ELI office for assistance in obtaining a phone number.

E-Mail Address

Address in Canada

This is the address of where you are living in Canada. If you are living in residence, please list the name of your residence and room number (example: Renison residence, room 203)

Unit/Apartment Number

House/Building Number and Street Name

City

Province

Postal Code

Emergency Contact Person

We require this information in case of an emergency. We prefer to have an emergency contact person in Canada. If you do not have an emergency contact person in Canada, you may list a person outside of Canada that is a reliable emergency contact.

Name

Telephone Number

Address or E-Mail address

Relationship to you:

(example: friend, mother, spouse, etc.)

Confirmation of information

I confirm that all information submitted in this form is true. If there are any changes to this information, I will notify Renison ELI reception immediately:

Click to confirm