APPLICATION/REGISTRATION FOR ADMISSION
Family Name:____________________ Given Name:_____________
Preferred Name: ____________________ Gender: ____________
Date of Birth (dd/mm/yy): ______/_______/__________ Country of Birth:_______________
Status in Canada:
Home Address:
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City: _____________ Province: ______________ Postal Code________________
Phone:_____________________ Email:______________________________________
Parent / Guardian Contact
Name:__________________________ Phone(Home):_______________________
Relationship:_________________________ Phone(Business):_____________________
Previous School(s) Attended
High School Name
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Grade)
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From (mm/yy)
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To (mm/yy)
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Certificate or Diploma Obtained
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TOEFL score:________________ Other English test score____________
Academic Program/Course Applying For
Course Code
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Course Name
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Prerequisite
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Start Date
( semester/year )
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Class Time
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I have provided the following supporting documents:
Identification Transcript Report Card Credit Summary Others
If I am accepted as a student at CIA, I hereby agree to abide by all the rules and regulations of the School.
I hereby declare that the information given in this application form is to the best of my knowledge complete and correct.
School shall under no circumstances be liable for any loss, damage or injury.
Signature of Applicant:_________________________ Date (dd/mm/yyyy):__________________________
Name of Parent or Guardian (if applicant is under 18):_________________ Date (dd/mm/yyyy)______________
Download:
Application Form.pdf
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