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INTERNATIONAL APPLICATION FORM International Application #______________ (office use only)
PRIMARY INFORMATION
Date of Birth: Month
First Name
Mr. Mrs. Ms.
Female Male
Second Name
Day Year
PERMANENT ADDRESS INFORMATION
Street
Country
Last Name
State
Code
Country of Citizenship
COUNTRY AND LANGUAGE
English French OtherFirst language (basis for admission consideration):
If other, please specify
Secondary school graduate or equivalent Please e-mail transcripts with your application. You must bring original or certified/notarized copies with you at the time of registration.College/University studies.
Yes No
ADDITIONAL ACADEMIC INFORMATION
Have you written the TOEFL? (550 paper and 213 computer based; 79 - 1BT)
If Yes, indicate the date it was written TOEFL Score
If Yes, indicate the date it was writtenNoYesHave you written the IELTS? (6.0 - no band score less than 5.5 accepted. For graduate programs 6.5 no band score less than 5.5)
Score:
Listening Reading Writing Speaking
Overall
Page 1 of 4
APPLYING TO NORTHERN? 1. Complete this form. 2. Remember to sign and date this application (Page 3). 3. Fax the form to 705.235.7279 or email to: [email protected] 4. Mail the original to:
Northern College Admissions International Office
P.O. Box 3211 Timmins, ON P4N 8R6
A $100 application fee is required to process your application and is payable by credit card or wire transfer (details on last page).
E-mail Address
Home Work
NumberCity CodeCountry Code
TELEPHONE CONTACT INFORMATION
(Please have your score sheet sent to us.)
INTERNATIONAL APPLICATION FORM International Application #______________ (office use only)
Page 2 of 4
1. Program
PROGRAM SELECTION (In order of preference)
Length
Start Date
Start Date
Length
2. Program
Start Date
Length
3. Program
Have you attended school or college in Canada before?
If Yes, indicate the date you attended and where:
NoYes
Program
School address
School attended
Date attended
Date attendedProgram
School address
School attended
Date attendedProgram
School address
School attended
FUTURE EDUCATION AND CAREER GOALSDo you plan to complete a diploma program and go on to University?
Yes No
NoYes
Are you planning to work in Canada for one or more years after graduation (as permitted by Immigration Canada)?
Freedom of Information and Protection of Individual Privacy Act: The information on this form is collected under the legal authority of the Ministry of Colleges and Universities Act, R.S.O. 1980, Chapter 272, S.S.,: R.R.O. 1980, Regulation 640. The information is used for administration and statistical purposes of Northern College and/or the Ministries and Agencies of the Government of Ontario and the Government of Canada. For Further information, please contact Student Services, Northern College, P.O. Box 3211, Timmins, ON, P4N 8R6. I certify that the above information is true and complete. I understand that any false or incomplete information submitted in support of my application may invalidate my application. I have read the Freedom of Information and Protection of Individual Privacy Statement.
AUTHORIZATION
DateSignature
Page 3 of 4
Pursuant to the Freedom and Protection of Individual Privacy Act, I hereby authorize Northern College to release any and all information related to any and all aspects of my application for admission, acceptance, fees or program of studies to the person whose name and address appears below. I certify that the person named is my selected representative and has my agreement to access and use this information to assist me to successfully register and access a program at Northern College. I authorize information release to my contact in Canada:
INFORMATION RELEASE
Contact's Name
Area Code
CONTACT'S TELEPHONE INFORMATION
Phone Number
E-Mail Address
DateSignature of Applicant
INTERNATIONAL APPLICATION FORM International Application #______________ (office use only)
Page 4 of 4
First Name
NORTHERN COLLEGE TUITION FEE PAYMENT/REGISTRATION FORM
INTERNATIONAL APPLICATION FORM International Application #______________ (office use only)
STUDENT INFORMATION
Last Name
Application Number (see top of the page)
Amount of Payment
Cardholder's Name
Expiry Date
Credit Card Number
Application Payment Information
VISA or MasterCard Wire Transfer
VISA or MasterCard Information
Cardholder's Signature
The following information will be required for a wire transfer: Bank: Royal Bank of Canada Address: 38 Pine Street North, Timmins, ON Canada P4N 6K6 Bank#: 003 Transit #: 05112 Account #: 000-013-3 Swift Code: ROYCCAT2 Please ensure the College is notified when the transfer has been processed and the amount of the transfer as it will be important to verify the deposit and to process the payment on your account. Please note that should a refund be required, the cost of the wire transfer will be added to the non-refundable $2500 administration fee (generally the wire transfer fee charged by the bank is $50). Please contact the International Office at [email protected] to confirm that the wire transfer has been sent. REFUND POLICY Please see the following web site page for more information http://www.northernc.on.ca/international