Program Application

Family Name *

Please enter your family name exactly as it appears in your passport.

First Name (Given Name) *

Please enter your given name exactly as it appears in your passport.

Pronouns

e.g. (They, Them, Theirs), (She, Her, Hers), (He, Him, His), (Ze, Zir, Zirs), etc.

Email (student's direct email address) *

Home Address *

City *

State/Province/Territory

Country *

Postal Code/Zip

Telephone *

(##) (###) (###-####)

Gender *

Male

Female

Non-Binary

None of the above

None of the above, I identify as:

Citizenship *

Please indicate if you are a Canadian Permanent Resident (PR): *

Yes

No

Native Language *

Are you a current university student? *

Yes

No

Name of University

Are you a sponsored or scholarship student? *

Yes

No

If yes, who is your sponsor/scholarship provider:

Coupon Code:

Current Level of English *

Are you using an agent to register for your program? *

Yes

No

Email student registration documents to *

Alternate Contact

Student

Agent

Emergency contact name *

Relationship *

Emergency contact telephone number *

Emergency contact email address *

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