International Student Application Form (Page 2 of 2) in pdf

Please send your com pleted application form to:

International C entre

Loyalist C ollege

W allbridge-Loyalist R oad

P.O . Box 4200

Belleville, Ontario

Canada

K8N 5B9

Fax: 1-613-969-0411

Em ail: international@ loyalistc.on.ca

A non-refundable application fee of C AD $150 m ust be sent with this form if you are applying for post-secondary program s. Bank

D rafts m ade payable to Loyalist C ollege. Personal C heques are not accepted.

M ethods of Paym ent:

Bank D raft

M oney Order:

C ertified C heque:

Bank Transfer:

Visa:

M astercard:

Am erican Express:

If paying by C redit C ard, please com plete the following:

C ard Num ber: _______________________________

Expiry D ate: _______________________

N am e on C ard: ________________________________________ Signature of C ardholder: _________________________

Feedback:

H ow did you learn about Loyalist C ollege?

R ecruiting Agency

Educational Fair

Advertisem ent

School C ounsellor

Internet

C urrent C ollege Students

Friends

M agazine/Publication

O ther: __________________________

Accom modations:

I will find m y own accom m odations:

… … …… ..

I wish to live in Residence:

Please send m e R esidence Inform ation:

… … … …

I need assistance with other housing arrangem ents:

Please send m e the H ousing Assistance Form :

… … … … .

I will require Airport Pick-up Services:

Please send m e the Airport Service Form

IN CASE OF EM ERGENCY:

Please provide the name, address, telephone number, and relationship of the person who we

m ay contact In the event of an em ergency

N am e: __________________________________________________________ R elationship: ______________________

Address: __________________________________________________________________________

Telephone Num ber: (H om e) ___________________(W ork) __________________E-m ail:_______________________________

Declaration:

I declare the above inform ation is true and com plete. I understand that any false or incom plete inform ation subm itted in support of

m y application m ay invalidate m y application and result in the withdrawal by Loyalist C ollege.

I authorize Loyalist C ollege to obtain details to m y academ ic record at the institutions listed previously in order to enable m y

application to be considered

Signature: ___________________________________________

D ate: ___________________________________

Student

Signature: ___________________________________________

D ate: ___________________________________

Parent/G uardian (if applicant is under 18 years of age)

Indicate w here you wish to have your Letter of Acceptance sent:

R esidence address (listed above)

M ailing address (listed above)

FOR OFFIC E U SE O N LY:

International Evaluation: com plete

To be com pleted

Freedom of Inform ation and Protection of Individual Privacy Act – The personal inform ation on this application is collected

under the authority of the M inistry of C olleges and U niversities Act, R .S.O ., 1980, c.M . 19s5. The inform ation is collected for the

purpose of statistical inform ation within the college. Please note that Loyalist em ployees are not perm itted to release inform ation

regarding any student to anyone other than the student him /herself. If you have any questions regarding the collection and use of

this inform ation, you m ay contact the Registrar of the College.

please turn over to complete form

2006 - 8822

International Student Application Form Page 2

Related Articles

Related forms

Related Categories