Application Form

Personal Information

First Name *

Last Name*

Middle Name

Birthday *

Gender *

Country of Citizenship *

Native Language*

Status in Canada *

Applicant's Contact Information

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone Number

Email *

Confirm Email *

Emergency Contact

Cannot be agent information. Overseas emergency contact is acceptable

Emergency Contact Name *

Relationship

Phone Number

Email *

Street Address

Apartment, suite, etc

City

State/Province

ZIP/Postal Code

Country

Program Information

Program interest*

Select all that apply

Advanced Placement

PRogram Test

Start date *

Previous Academic Background

From

To

Previous School Name(s)

Grades Completed

English Proficiency Score *

IETLS

TOFEL

Other

Not applicable

Agency Information

Agency

Agency ID

Contact Person

Email Address

Medical & Additional Information

Do you have medical insurance? *

Yes

No

Do you have any allergies? *

Yes

No

Do you have a physical or mental medical condition? *

Yes

No

Do you have a guardian in Canada? (Under 18 years old only) *

Yes

No

Do you have accommodation? *

Yes

No

Do you need an airport pick-up service? *

Yes

No