International Education Department

3330 22nd Avenue, Prince George, British Columbia

V2N 1P8 CANADA
Telephone: (250)561-5857 Fax: (250)561-5856
Email: intl_edu@cnc.bc.ca
Website: www.cnc.bc.ca/ined

International Student
Application for
Admission Form
Application Fee: $125 (Non Refundable) CNC Student Number:

PROGRAM APPLIED FOR

Name of Program you are applying for:

ESL ESL + University Transfer ESL + Business Certificate/Diploma University Transfer

Business Certificate/Diploma Other (See attached cover sheet for list of available programs) ___________________
Start Date: September January May Year:

STUDENT INFORMATION
Last/Family Name: First Name:

Birthdate: _________/_________/_________ Gender: Male Female

Year Month Day Citizenship (Country) ___________________________

YOUR PERMANENT ADDRESS (Home Country)

Street Address:

City: District/State: Country:

Postal Code: Email: Phone or Cell Phone:

EMERGENCY CONTACT
Name of Emergency Contact Relationship to You: (Example your Mother or Father)

Phone or Cell Phone: Email:

CURRENT MAILING ADDRESS (ONLY COMPLETE IF YOU ARE CURRENTLY LIVING IN CANADA)
Street Address:

City: Province/Postal Code:

Phone or Cell Phone: Email:

AGENT MAILING ADDRESS AND INFORMATION (ONLY COMPLETE IF YOU HAVE AN AGENT)
Name of Agent or Company Name:

Street Address:

City: Province/District/State Country:

Postal Code: Email: Phone or Cell Phone:

MAIL MY LETTER OF ACCEPTANCE TO: My Permanent Address My Agent

IMMIGRATION DETAILS
Passport # _____________________ Passport Issue Date ___________________ Passport End Date __________________
Country of Issue ________________________________
Do you have a Study Permit? No Yes If yes: Study Permit # _____________ Permit Start Date _____________
Permit End Date _____________

PREVIOUS EDUCATION (For all programs other than ESL, official transcripts are required)
Last Secondary School Attended: Country: Grade Completed: Year:

Last College of University Attended: Country: Program Completed: Year:

ESL Credentials: TOEFL IELTS OFFICIAL DOCUMENTS MUST BE INCLUDED WITH THIS
APPLICATION FOR ALL PROGRAMS OTHER THAN ESL
Score __________ Score ____________

ACCOMMODATIONS
Homestay Complete Homestay Application Form (included in this package)

Private Accommodations (only check this box if you have a relative or friend in Prince George)

HOW DID YOU HEAR ABOUT CNC?

PLEASE CIRCLE ONE: FAIR (Name of Fair ____________________) AGENT STUDENT
MAGAZINE ADVERTISEMENT (Which one? ______________________________)
CNC WEBSITE OTHER WEBSITE (Which one? _____________________)
OTHER _______________________________________

METHOD OF PAYMENT ($125.00 NON-REFUNDABLE IN CANADIAN FUNDS IS REQUIRED AT

TIME OF APPLICATION)

Credit Card Visa OR Mastercard Card Number ________________________________________

Expiry Date ____/_______
Name on Card ____________________________ Cardholder Signature __________________________________

Bank Draft/Cheque Wire Transfer (Attach copy of banking details)

RELEASE OF INFORMATION

I give permission for the College of New Caledonia to release my information or contact my agent, or the person I have named
on my application form as an Emergency Contact in situations the College decides are urgent, including, for example, health
problems, safety concerns and wellness.
Further, I give permission to allow the College of New Caledonia International Education staff to provide information regarding
my academic progress, attendance and grades to my agent, or the person I have named on my application form as an
Emergency Contact.
I also grant permission for the College of New Caledonia to use my written comments, or photographs of myself, either in a
group or individually taken during special events and activities, for the purpose of promoting the College of New Caledonia.
The information on this form is collected under the Authority of the Freedom of Information Protection of Privacy Act (Part 3,
Division 1, Sec. 267 c). The information provided will be used in accordance with the Act (Part 3, Division 2, Sec. 32 (a)). If you
have any questions about the collection and use of this information, contact the Freedom of Information Coordinator, College
of New Caledonia.
I hereby accept and agree to the terms and conditions listed above:

Signature of Student Applicant ________________________________________ Date: ______________________________