Please make sure all required fields are filled out correctly (*)

Indicate the program for which you are applying:
– Please select the campus*:
Please select your preferred test date*:
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 :     

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

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




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