COLUMBIA COLLEGE APPLICATION FOR ADMISSION

ATTACH PHOTO HERE 500-555 SEYMOUR STREET VANCOUVER, B.C. V6B 6J9 CANADA TEL 604-683-8360 FAX 604-682-7191 admin@columbiacollege.ca www.columbiacollege.ca
This form is also available online at www.columbiacollege.ca

Please print clearly in block letters and enclose required documents and application fee with this form. This application is submitted by
SURNAME (FAMILY NAME)

Self (direct applicant)

GIVEN NAMES

Columbia College authorized overseas study agency

MALE FEMALE

BIRTH DATE
DAY MONTH YEAR

PERMANENT HOME ADDRESS

CITY
COUNTRY CODE

PROVINCE

COUNTRY

POSTAL CODE

CITY CODE

TELEPHONE

FAX

CITIZENSHIP E-MAIL ADDRESS

STUDY PERMIT (expiry date) VISITOR VISA (expiry date) PERMANENT RESIDENT CANADIAN CITIZEN
CDN. CITIZENSHIP # OR BIRTH CERTIFICATE

VANCOUVER AREA ADDRESS

CITY

POSTAL CODE

VANCOUVER AREA TELEPHONE

VANCOUVER CONTACT

TELEPHONE

SELECT ONE OF THE PROGRAMS:

University Transfer Program
Intended Program: Liberal Arts Science Communication Business Computer Science Engineering Other

University Foundation Program

Accelerated Secondary Program Adult Secondary Program High School Completion Program Senior Secondary Program University Preparatory Program

Academic ESL Program General ESL Program

Full-time (25 hours/week) Part-time (10, 15, 20 hours/week)

HAVE YOU APPLIED TO COLUMBIA COLLEGE BEFORE?

Semester Applying For: Winter (JanApr) Summer (MayAug) Fall (SepDec)

Semester Applying For: Winter (JanApr) Summer (MayAug)

LEAVING DATE

Entry Points Fall (SepDec)

Sept 8 2009 March 8 2010 Oct 26 2009 May 17 2010 Jan 11 2010 July 5 2010

Length of ESL Study 7 Weeks 14 Weeks 21 Weeks 28 Weeks Other (specify)

Yes

No

GRADUATING HIGH SCHOOL (if applicable)

FORM/GRADE/QUALIFICATION COMPLETED

DO YOU REQUIRE HOMESTAY ACCOMMODATION?

LAST SCHOOL/COLLEGE ATTENDED

LEAVING DATE

FORM/GRADE/QUALIFICATION COMPLETED

YES

NO

If yes, we will send you a homestay application form to complete.

THIS SECTION TO BE COMPLETED BY APPLICANTS UNDER 19 YEARS OF AGE PARENT OR GUARDIAN NAME: Mr. Ms.

PARENT/GUARDIAN ADDRESS & PHONE SAME AS PERMANENT ADDRESS/PHONE

STREET ADDRESS

VANCOUVER ADDRESS/PHONE OR

CITY

COUNTRY

POSTAL CODE

AREA CODE

TELEPHONE

FAX

ENCLOSURES:

APPLICATION FEE

TRANSCRIPTS

TOEFL

LPI

IELTS

PHOTO

I AGREE TO ABIDE BY THE OFFICIAL COLLEGE POLICIES AND REGULATIONS, INCLUDING THOSE CONCERNING DISMISSAL, DISPUTE RESOLUTION AND REFUNDS, AS SET OUT IN THE CURRENT COLUMBIA COLLEGE CALENDAR. I UNDERSTAND THAT A COPY OF THIS CALENDAR IS AVAILABLE ON THE COLUMBIA COLLEGE WEBSITE AT: www.columbiacollege.ca

COLUMBIA COLLEGE AUTHORIZED REPRESENTATIVE STAMP

*
* MUST BE SIGNED BY APPLICANT, OR BY PARENT/GUARDIAN IF UNDER 19

DATE: DAY MONTH YEAR

OFFICE USE ONLY

STUDENT NUMBER

PLACEMENT AMOUNT PT ADMITTED ON BASIS OF:

YEAR REMARKS:

A T T P HF HS R

DATE

CR#

ADMITTING OFFICER SIG:

April 2009

Information on this form is collected to allow Columbia College to identify and communicate with the applicant. Personal information will be treated as confidential in accord with the College's policies on privacy. See the Columbia College calendar at www.columbiacollege.ca for policies.