International Student Application Form
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1
2INTERNATIONAL STUDENT APPLICATION FORM
Personal Information:
Fam ily N am e:
G iven N am e (s):
D ate of Birth:
Year:
M onth:
Day:
C itizenship:
M ale:
Fem ale:
First Language:
O ther:
C urrent Status in Canada:
Student Authorization/Student Visa:
O ther:
Residence Address:
Street Address:
C ity:
Province/State:
C ountry:
Postal C ode (ZIP):
Phone N um bers: Hom e (
)
O ther: (
)
Em ail Address:
Fax N um ber:(
)
M ailing address in Canada: (if different from above)
Street Address:
C ity:
Province/State:
C ountry:
Postal C ode (ZIP):
Phone N um bers: Hom e (
)
O ther: (
)
Em ail Address:
Fax N um ber:(
)
Contact Person in Canada:
(com plete only if application is being subm itted by som eone in Canada on behalf of the
applicant ex. recruiting agent )
N am e: _____________________________________
Address: ________________________________________
Telephone: _________________________________
E-m ail Address: __________________________________
Academic Information:
Post-Secondary Program (Please indicate two program choices and the term in which you wish to begin your studies)
Program Title:
Program Length:
Start D ate (m onth/year)
1.
2.
3.
Academ ic History:
H ave you previously applied to Loyalist C ollege?
Yes
N o
N am e of school m ost recently attended: ________________________ Are you or will you be a graduate by the first day of college?
Secondary School Graduate Yes
N o
Secondary School Transcript:
Attached
To follow
N/A
C ollege G raduate
Yes
N o
C ollege Transcript:
Attached
To follow
N/A
U niversity Graduate
Yes
N o
U niversity Transcript:
Attached
To follow
N/A
English Proficiency:
(If English is not your first language, you m ust provide proof of English proficiency.)
Score:
TOEFL:_______
IELTS: _______
C AEL: _______
O ther: _____________ Attached
To follow
N/A
Test C om pleted:
D ate(D /M /YR ): ______________
C ountry: _________________
Procedure for Paym ent:
please turn over to complete form
2006 - 8822
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