Application

Name*
Sex* Male Female
Birthday*
Date of Application*
Address Line 1*
Address Line 2
Postal Code*
Home Phone*
Cell Phone
Fax
Email*
Alternate Email
BCID Number
Drivers License
Are you of First Nations descent?* Yes No
Were you born in Canada?* Yes No
If not, please specify country of birth...
Arrival Date in Canada
Elementary School Attended*
High School Attended*
Did you receive any learning support (e.g. ESL)?* Yes No
Please specify...
Do you have computer access?* Yes No
How do you plan to get to school?* Bus Bike Walking Other
Are you receiving financial assistance?* Yes No
Please specify...*
Have you received a blood test?* Yes No
Have you received a TB test?* Yes No
Do you have any disabilities?* Yes No
If so, please specify...
What is your cultural background?*