STUDENT INFORMATION

Last Name: First Name:

Gender:  Male Female

First Language:

Date of Birth: Month: ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day: ---12345678910111213141516171819202122232425262728293021 Year: ---1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010

Country of Birth:

Status in Canada:  Canadian Citizen Permanent Resident Student Visa

HOME ADDRESS

Street Address:

Apt. #:

City: State:

Zip Code: Country:

Telephone:

Email:

EDUCATION BACKGROUND

Name of School:

From Year: To Year:

Diploma:

Country:

Name of School:

From Year: To Year:

Diploma:

Country:

PARENT/GUARDIAN INFORMATION

*If the applicant’s Legal Guardian in Canada is not a parent, please enter the Legal Guardian’s information below, including relationship to the applicant and PLEASE attach a copy of a notarized legal guardian/custodianship documents to this application.*

Father's Name:

Date of Birth: Month: ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day: ---12345678910111213141516171819202122232425262728293021 Year: ---1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010

Address:

City: State:

Zip Code: Country:

Phone: Fax:

Email:

Mother's Name:

Date of Birth: Month: ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day: ---12345678910111213141516171819202122232425262728293021 Year: ---1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010

Address:

City: State:

Zip Code: Country:

Phone: Fax:

Email:

(if applicable) Legal Guardian in Canada

Name:

Address: City:

Province: Postal Code:

Phone: Fax:

Email:

Relationship to Application:

I acknowledge that the information provided is true