Durham College Application Form
3
Program choice Priority Program title Code Start date (month/year) 1 2 3 English as a Second Language/ English for Academic Purposes September Late October January March May July International student application Personal Details Male Female Mr. Mrs. Miss Ms. Surname (family name) Given (first) name Nationality Date of birth (DAY/MONTH/YEAR) Student’s mailing address Street name and number Apt. City/prefecture Country Postal code Home telephone number Alternate number Fax number E-mail Academic record Trans cr ip ts enclosed? Y es No T o Follow Funds Enclos ed ? $100 CD N applic at ion fee (see Page 2 for payments) Last school attended Address City Country Highest level passed TOEFL score (if available) Other English assessment In your sc hooling, was English the main langua ge of instru cti on? Y es No If yes, how many years?
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Transcript of Durham College Application Form
8/8/2019 Durham College Application Form
http://slidepdf.com/reader/full/durham-college-application-form 1/2
Program choice
Priority Program title Code Start date (month/year)
1
2
3
English as a Second Language/ English for Academic Purposes
September Late October January March May July
International student application
Personal Details
Male Female Mr. Mrs. Miss Ms.
Surname (family name) Given (first) name
Nationality Date of birth
(DAY/MONTH/YEAR)
Student’s mailing address
Street name and number Apt.
City/prefecture Country Postal code
Home telephone number Alternate number
Fax number E-mail
Academic record
Transcripts enclosed? Yes No To Follow Funds Enclosed? $100 CDN application fee (see Page 2 for payments)
Last school attended
Address City Country
Highest level passed TOEFL score (if available) Other English assessment
In your schooling, was English the main language of instruction? Yes No If yes, how many years?
8/8/2019 Durham College Application Form
http://slidepdf.com/reader/full/durham-college-application-form 2/2
In case of emergency – contact person
Surname (family name) Given (first) name
Street name and number Apt.
City/prefecture Country Postal code
Home telephone number Alternate number
Fax number E-mail
Accommodation
I will not need help with accommodation I would like information on homestay
I would like to stay in residence I will require airport pickup
Feedback
How did you hear about Durham College?
Why did you apply?
Declaration
I certify that the above information is true and complete. I understand that any false or incomplete information submitted in support ofmy application may invalidate my application and result in the withdrawal by Durham College of any offered place, and that thiswithdrawal may also take place at any time during my enrolment. I authorize Durham College to obtain any details relating to myacademic record at the institution(s) listed on reverse in order to evaluate my application.
Applicant signature Date
Please mail this completed application, including secondary school transcripts and the $100 CDN application fee, to:
Durham College International office
2000 Simcoe Street North, Oshawa, Ontario, Canada L1H 7K4
Phone: 905.721.2000 ext. 2355 | Fax: 905.721.3372 | E-mail: [email protected]
Payment may be made by certi f ied cheque (payable to Durham College),money order, MasterCard, Visa and/or e lectronic bank transfer.
Card name Name of cardholder
Card number Expiry date
Cardholder signature
Agency information (educational/recruitment service if applicable)
Agency name
City Country
In accordance with section 39(2) of the Freedom of Information and Protection of Privacy Act, you are advised that the personal information collected on this form iscollected under the authority of the Ministry of Colleges and Universities Act, R.S.O., 1990 and Regulation 770. It will be used by Durham College personnel only forrelevant College activities and may be used for statistical and administrative reporting purposes of the College. No personal information will be made available to third parties.
