Apply > Application Form - International Student Program, Qualicum Beach, Vancouver Island, Canada


Family Name

If you use an English name, please indicate

Called Name (Given Name)

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 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