Program Application Form
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1McKenzie College Program Application Form
320 Logan Road
74 Townsend Street
Bridgewater, Nova Scotia B4V 3J8
Sydney, Nova Scotia B1P 5C8
tel: 902-530-3606 fax: 902-530-3607
tel: 902-562-8549 fax: 902-567-2003
Please read this application carefully and submit the completed application form including fee, transcript and appropriate supporting documents to: The Registrars O ce,
McKenzie College, Sydney Campus, Sydney, Nova Scotia B1P 5C8. Please refer to the deadlines published for the program which applies to you. Enrollment is limited and we
recommend that you submit your completed application as early as possible. Missing fees or incomplete documentation will slow the registration process. A non-refundable
fee of $50.00 must accompany your application. Please make cheques payable to McKenzie College, Sydney. Please include the name of the applicant on the cheque. Students
must submit a nal transcript showing that they have met the minimum requirements for the program for which they have applied. Admission requirements for all programs
include Grade 12 or GED or Mature Student status. All applicants are requested to submit a one page personal pro le letter outlining your ambitions, goals, career objectives
and why you are interested in the program you are applying for.
Personal Information
INITIAL
S U R N A M E
FIRST NAME
FIRST NAME
INITIAL
SURNAME
ADDRESS
ADDRESS
CITY
PRO VINCE
P O S TAL C O DE
CITY
PROVINCE
POSTAL CODE
-
TELEPHONE
S OCIAL IN S URA N C E NU MBER
DATE O F BIRTH (MM-DD-YYYY)
TELEPHONE
SOCIAL INSURANCE NUMBER
DATE OF BIRTH (MM-DD-YYYY)
-
-
-
-
-
-
E-MAIL ADDRESS
E-MAIL ADDRESS
E-MAIL ADDRESS
DRIVERS LICENSE MASTER NUMBER
High School/College/University Attendance Information
Course Selection
Program Applied For:
Campus: Sydney
South Shore
Enclosures:
Registration Fee
Copies of Certi cates / Diplomas
Personal Pro le Letter
Criminal RecordCheck
Drivers Abstract
Drivers License
Medical Examination
Letters of Reference
Declaration
I hereby certify that all the all the information provided in this application form is complete and accurate. I authorize the College to verify any information contained herein. I
understand that falsi cation of any information within this application may be considered grounds for non-admission or dismissal after admission. I agree to abide by the
rules and regulations of the College. I agree to pay all fees associated with my registration at the College. I understand that acceptance is solely at the discretion of the
Registrar of the College and that their decision is nal.
SIGNATURE
DATE
NAME (please print)
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