Personal Information:

*Last Name:

*First Name:

Initial:

Street / PO Box:

City / Town:

Province / State:

Other Province:

Country:

Postal / Zip Code:

*Home Telephone:

*Email Address:

*Citizenship:

Date of Birth (dd/mm/yyyy):

/ / Male Female

Who should we contact in the event of an emergency?

Last Name:

First Name:

Initial:

Street / PO Box:

City / Town:

Province / State:

Other Province:

Country:

Postal / Zip Code:

Home Telephone:

Email Address:

Relationship:

Enrollment Information:

Preferred Start Date:

/ / (dd/mm/yyyy)

Program: 1st Choice:

Program: 2nd Choice:

Program: 3rd Choice:

To better serve students, upon acceptance into his/her program of choice, Academy Canada wishes to know of any disabilities (ie. learning disability, physical disability or other circumstances) that may affect program delivery.

Educational Information:

Are you a current high school student?

Yes

What year will you graduate?
(yyyy)
What school are you attending?

No

What grade did you complete?
Year? (yyyy)
School Attended

Which best describes your educational background? Check all that apply.

In high school and will graduate in the year (yyyy)

High School Graduate, graduated in the year (yyyy)

Attending another College or University, Name of school:

What languages are spoken in the home?

How would you describe your English skills? Beginner Intermediate Advanced

What is your score on TOEFL (or equivalent)? *

When did you write this test? (yyyy)

*Please attach copy of TOEFL results.  Applicants who can not complete a TOEFL exam will be assessed individually by Academy Canada personnel.

Financial Information:

Optional: If you wish to apply for our Homestay Program, please complete the following:

State of health:

Excellent Good Fair Poor

Medications, Allergies, Food Exclusions, if any please list:

Student Character:

List five attributes that best describe your personality:

Interests and hobbies:

What are your future goals?

Notice of Waiver:
Every effort is made to ensure the accuracy of this information as of the date of publication; however, information of this type tends to become outdated with time. The College, therefore, reserves the right to modify or cancel any program, option, course, objective, fee, timetable or campus location without notice or prejudice. The College also does not assume responsibility for changes made after publication or in areas beyond its control because, while course outlines are updated annually, textbooks, materials and information change with little or no notice. The College reserves the right to modify, change, add or delete topics without notice or prejudice.

I, the applicant, understand and agree to the abovementioned policies. I further agree that my acceptance to any program is subject to sufficient enrollment.

Date of Application / / (dd/mm/yyyy)