centennialcollege.ca/programs/inter/apply.html Please complete and return to: International Education, Centennial College P.0. Box 631, Station A, Toronto, ON M1K 5E9 ‘Once your application form s received atthe college, an acknowledgment wil be issued o you with further nformation about the admissions process, Please type or print clearly Name Last Name (Family Name, Sumame) First Name (Given Name) Second Name Date of Birth Female Male Month Day Year Country of Citizenship Country of Residence Are you applying from within Canada? Yes, lam in Canada now {O.No, | am applying from outside Canada Residence address Street Number and Name Apartment Number City. Province/State Country Postall2ip Code Phone fax. Country Code Area Code Phone Number Country Code Area Code Fax Number E-mail Fist Language english french ‘Other (Please specify). Mailing address (if different from residence address above) Street Number and Name Apartment Number City, Province / State Country _PostaliZip Code | certify that the information inthis form is true and complete. | understand that any felse or incomplete information submitted in support of ‘my application may invalidate my application, | have further reed and understood the Freedom of information and Protection of Individual Privacy Statement below, Applicant Signature Date Freedom of Information and Protection of Individual Privacy Act. The information on this form i collected under the legal authority ofthe min- istry of colleges and universities act. 5.0, 1980, Chapter 272, SS; R.R.O. 1980, Regulation 640, The information is used for administration and statistical purposes of Centennial College andlor the Ministries and Agencies ofthe Goverment of Ontario and the Government of Canada, For further information, please contact Intemational Eduction, Centennial College, PO Box 631, Station A, Toronta, Ontario, Canada Mik 5E9. HE aPlease Complete Al el Uiseh Lei eWay dell Name ‘Last Name (Family Name, Surame) First Name (Given Name) ‘second Name Basis for Admission Consideration LA Secondary School Graduate or Equivalent Collage/Univesty Studies {Attach Original and Notarized Transcripts in Erilish) Language Proficiency (Check the test you have taken and provide your score) TOEFL Score o tetrs. Score D MELAB Score Program Choices (Please ist in order of preference) Program Name Program Number Start Date (Year/Month) 1 2 3 Have you attended school or college in Canada before? Yes a No {ifyes please give names of choos, adresses and programs) School Name and Address Program Name Date attended Information Release Pursuant to the Freedom of Information and Protection of Individual Privacy Act, I hereby authorize Centennial College to release any and all information related to any and al aspects of my application for admission, acceptance, fees or program of studies tothe person whose name and address appears below | certify that the person named is my selected representative and has my agreement to access and use this infor Imation to assist me to successfully register and access programs at Centenrial College | authorize information release to my representative Name Address. Phone (including area code). E-mail Applicant Signature Date Please complete both sides of this form