Personal Details ( Name must be as it is on your passport ) Title Mr . Mrs . Miss Ms . Family Name First Name Second Name Date of Birthday : Month : Year : Sex Female Male
Address ( printed on letter )
House / Apt # Street City
Province / State Postal Code Country
Current Mailing Address ( if different than above )
House / Apt # Street City
Province / State Postal Code Country
Home Telephone Fax
Work Telephone Applicant Email
First Language Country of Citizenship Passport Number
Agent Information
Are you working with an Agent ? Yes No
Referral
If “ Yes ”, please provide Agent ’ s Name Agent Name Agency Email Address
English for Academic Purposes ( EAP ) Programs
Weeks of study Choose your START date Choose your FINISH date 7 weeks July __________ year August __________ year 14 weeks ( 1 semester , 4 months ) September __________ year October __________ year 21 weeks October __________ year December __________ year 28 weeks ( 2 semesters , 8 months ) January __________ year February __________ year 35 weeks March __________ year April __________ year 42 weeks ( 3 semesters , 1 year ) May __________ year June __________ year
Post Secondary 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
Co-operative Education Programs ( ONLY applicable if you applied to a co-op program ) 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 ( ie : TOEFL , IELTS , CAEL )? Yes No Name of English Test Taken English Test Score Date of English Test taken or to be taken Name of Last School Attended Official Transcripts included in this application ? Yes No
Highest Level Passed
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 ___________________________________________
INTERNATIONAL STUDENT APPLICATION FORM
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