Office use only: Student ID #______________________________
PERSONAL INFORMATION Male Female Date of Birth: Year: Month: Day: Nationality: Family Name: Gien Name !s": Mailin# $ddress Street Num%er and name: &ity: 'roince(State: &ountry: 'ostal &ode: 'hone Num%ers: )ome ! Include country code " *or+ ! " ,-Mail: Fa. Num%er: ! " First /an#ua#e: Other: &ountry of Ori#in: Contact Person in Canada !com0lete only if a00lication is %ein# su%mitted %y someone in &anada on %ehalf of the a00licant" Name: 1ele0hone: ,-mail: )o2 did you hear a%out St3 /a2rence &olle#e4 ___________________________________________________________________ $re you usin# a recruitin# a#ency4 Yes No $#ent Name: ________________________________________________________________________________ $#ent ,-mail: _________________________________________________________________ PROGRAMME of STUDY 'lease enter your choice of 0ro#rammes %elo2 '5OG5$MM, &OD, !IF 6no2n" '5OG5$MM, 1I1/,(&$M'7S '5OG5$MM, /,NG1) S1$51 D$1, 83 Month Year 93 Month Year :3 Month Year OFFI&, 7S, ON/Y: I&$S: ____________________________________ $00lication Fee: ____________________________ ,n#lish: ___________________________________ /O$ S,N1: ________________________________ ACADEMIC RECORDS Original or Certificated coies of !o"r #ost recent $ig$%sc$ool& college or "ni'ersit! transcrit and Englis$ Testing Scores are re("ested) Candidates #"st also send Englis$ translations *$ere necessar!) T$e doc"#ents #"st acco#an! !o"r alication for#) ACCOMMODATION I 2ould li+e to a00ly for : I 2ill arran#e for my o2n accommodation )omestay 5esidence I need assistance 2ith other housin# arran#ements PROCEDURES FOR PAYMENT 'lease send your com0leted a00lication form to: International Ad#issions St) La*rence College +,, Ports#o"t$ A'en"e -ingston& Ontario -.L /A0& Canada Fa.: 8-;8:-<=<-:>=: ,mail: international?sl3on3ca $ttention: )elen &had2ic+ $ non-refunda%le a00lication fee of &$D @8AA must %e sent 2ith this form if you are a00lyin# for 0ost-secondary 0ro#rammes3 'lease ma+e drafts 0aya%le to St3 /a2rence &olle#e3 Methods of 'ayment !chec+ one": BIS$ M$S1,5 &$5D Ban+ Draft(Money Order Other
If 0ayin# %y BIS$ or M$S1,5 &$5DC 0lease com0lete the follo2in#: &ard Num%er:________________________________________ ,.0iry Date: ________________________ Name on &ard:______________________________ Si#nature of &ardholder:_________________________ DECLARATION I declare the a%oe information is true and com0lete3 I understand that any false or incom0lete information su%mitted in su00ort of my a00lication may inalidate my a00lication and result in the 2ithdra2al %y St3 /a2rence &olle#e of a 0lace 2hich may %e offered and that this 2ithdra2al may ta+e 0lace any time in my enrolment3 I authoriDe St3 /a2rence &olle#e to o%tain details to my academic record at the institutions listed 0reiously and from 2hom I hae 0roided transcri0ts in order to ena%le my a00lication to %e considered3 Si#nature: ____________________________________________ Date: ______________________________________ $00licant Si#nature: ____________________________________________ Date: ______________________________________ 'arent ( #uardian(&anadian &ontact 'erson !if a00licant is under 8E years of a#e" Alication C$ec1list2 &om0leted a00lication form Ori#inal documents or certified co0ies of all academic transcri0ts and ,n#lish lan#ua#e 0roficiency test results3 ,n#lish translation of documents $00lication fee Once !o" are acceted& !o" *ill need to co#lete t$e $o"sing alication for# if re("ired)