International Experience Canada Application Form

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International Experience Canada Application Form 2016
SECTION ONE
SECTION THREE
PLEASE COMPLETE IN INK USING BLOCK LETTERS OR TYPED.
Age at time of Application ________________
Make sure all information is accurate and spelled correctly. It
Date of Birth ____Day ______Month _____Year
is important that your name exactly matches the name on
your passport.
Place of Birth ___________________________
MS
MR
Are you an American Citizen? Yes
No
Last Name ________________________________________
Do you have an American Passport which will be valid for the
duration of your stay in Canada? Yes
No
First Name ________________________________________
US Passport Number ____________________________
Middle Name ______________________________________
Expiration Date ________________________________
Permanent Address _________________________________
City____________________ State_______ Zip ___________
Have you participated in the SWAP program to Canada
Telephone (
) ________________________________
before? Yes
No
Cell (
) _______________________________________
Marital Status
Single
Married
Divorced
Email (required) ___________________________________
Post-Secondary Student Status:
EMERGENCY CONTACT
Full time within 11 months of application in an accredited
Name ___________________________________________
college or university outside of Canada
Relationship to You ________________________________
Telephone (
) __________________________________
Name of School ________________________________
Cell (
) _______________________________________
Email ____________________________________________
SECTION TWO
Estimated Arrival Date into Canada:
_______ Day _________ Month ________ Year
(This date must comply with program eligibility dates)
I plan to attend orientation in:
T oronto
Vancouver
I will enter Canada through another entry point: Please
specify _____________________________
I certify that I meet the eligibility criteria for the SWAP Work in Canada program and that I have truthfully completed this application
form. Furthermore, I have read the Application Conditions section on the SWAP website and agree to be bound by the contents. I
HAVE A MINIMUM OF $2500 USD AVAILABLE FOR MY WORK IN CANADA EXPERIENCE. I UNDERSTAND THAT MY REGISTRATION FEE
IS NONREFUNDABLE.
NAME ____________________________ SIGNATURE ________________________________________ DATE _______________

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