Georgian College

Personal details (Name must be as it appears on your passport) Title Mr. Mrs. Miss Ms. Family name First name Date of birth: Month: Address (printed on letter) Current mailing address (if different than above) Year: House/Apt # House/Apt # Second name Sex Female Male Street City Province/State Postal code Country Street City Province/State Postal code Home telephone Country Work telephone Fax Applicant email First language Country of citizenship Passport number Agent information If "Yes", please provide agent's name Are you working with an agent? No Agent name Agency email address English for Academic Purposes (EAP) programs Weeks of study Choose your FINISH date August __________year Choose your START date July __________year 7 weeks September __________year February __________year March __________year April __________year May __________year 28 weeks (2 semesters, 8 months) December __________year January __________year 21 weeks October __________year October __________year 14 weeks (1 semester, 4 months) June __________year 35 weeks 42 weeks (3 semesters, 1 year) Postsecondary programs Which program(s) are you applying to Start Date 1st Choice Program name Code Length (years) Month Year 2nd Choice Program name Code Length (years) Month Year 3rd Choice Program name Code Length (years) Month Year For co-operative education program applicants only: I understand that I have applied for a co-operative education program and it is my responsibility to find the co-operative work placement. Georgian College does not guarantee any student a co-operative position. Signature of applicant (Type in full name) ________________________________________________________________________ Date _________________________________ Academic information Is English your first language? Yes No If NO, have you taken any English tests (i.e:, TOEFL, IELTS, CAEL)? Name of English test taken English test score Name of last school attended Yes No Highest level passed Official transcripts included in this application? Yes Date of English test taken or to be taken No Freedom of information and privacy notification The personal information collected on this application is collected under the legal authority of the Colleges and Universities Act, Regulation 640. The information is collected for the purpose of statistics gathering for research and reports within the colleges, Ontario Ministry of Education and Training and Canadian non-government agencies. For further information regarding this collection, please contact the Registrar, 705-728-1968, ext. 1772 or fax 705-722-5123. Declaration I declare that the information contained in this application is true and complete. I understand that any false or incomplete information submitted in support of my application may invalidate my application and result in the withdrawal by Georgian College of a place which may be offered, and that this withdrawal may also take place at any time during my enrolment. "I authorize Georgian College to obtain any details relating to my academic record at the institutions listed previously in order to enable my application to be considered. I authorize Georgian College to release and obtain information from Canada Immigration related to study permit authorization. I understand that Georgian College will deduct $500 as an administrative charge in case of a withdrawl." Signature of applicant (Type in full name) ______________________________________________________________ Date ___________________________________________ One Georgian Drive, Barrie, ON L4M 3X9 | Tel: 705-728-1968, ext. 1218 | Fax: 705-722-5158 Website: georgiancollege.ca/international | Email: international@georgiancollege.ca INTERNATIONAL STUDENT APPLICATION FORM Yes Referral

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