Indicate the program for which you are applying:
Indicate the semester for which you are applying:  Fall   |  Winter   |  Spring   |  Summer   -   Year 


Family Name at Birth: First Name:
Gender:  Male Female Date of Birth:     
How did you hear about us? Website   |  Alumni   |  Friend   |  Newspaper   |  Flyer   |  Emploi Québec   |  Social Media


Number: Street/Rural Route/P.O. Box: Apartment:
City/town: Province:
Country: Postal Code (important):
Telephone: Area Code
Number
Cell  Work Area Code
Number
Ext.
Email:


Father’s Family Name: Father’s First Name:
Mother’s Maiden Name: Mother’s First Name:
Mother Tongue:   English   |  French   |  Other - Specify:
Language Normally Used:   English   |  French   |  Other - Specify:
Place of Birth: City: Province OR Foreign Country
Status in Canada:   Canadian   |  Aboriginal (First Nations, Métis, Inuit - Band: )
Permanent Resident   |  Student Visa   |  Refugee   |  Other - Specify:


1. QUÉBEC PERMANENT CODE (if you studied in QC):
2. When did you obtain your High School Diploma? (month/year)
Name of the Institution:
Province: Country:
3. Have you ever taken, or are you taking, courses at the College or University level?
Name of the Institution:
When did you attend? From
Date
to
Date