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Legal Surname
(Last Name)
Legal First Name
Legal Middle Name(s)
If you use an English name, please indicate
Birth Date
Gender
Male
Female
Father's Full Name
Father's Birth Date
Mother's Full Name
Mother's Birth Date
Your Home Country
Mailing Address
Telephone
Fax
Student's Email
Parent's Email
I would like to attend
Full Year
1st Semester
2nd Semester
I am Currently Enrolled in
Grade / Semester
Name of last school
attended in home country
Address last school
How many years have you attended school?
I wish to Graduate in British Columbia:
Yes
No
I wish to develop English only:
Yes
No
When I complete this program I intend to:
Apply to a Canadian/U.S. College / University
Apply to a University in my own country
I will not be applying to University
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