Visiting Request Form

VISITING UNDERGRADUATE STUDENT AUTHORIZATION TO REGISTER Office of the Registrar 46 Please Print Clearly — (NAMES; must reflect the names indicated on your supporting documents.) Name Family Name Given Name Family Name at Birth Date of Birth Day/Month/Year Sex Male Female Address Street Number Street Name Apt. Number City Province/State Country Postal/Zip Code Telephone: Home ( ) Other ( ) Area Code Area Code Have you previously applied to/registered at this University? A Father’s Name Family Name Given Name Mother’s Name Family Name Given Name Your Place of Birth City Country Province (if in Canada) All students are required to have a permanent code assigned by the Québec Ministry of Education, of Leisure and Sport. All candidates should complete this section. C MELS Code Permanent (if available) Authorization Permit I am an international student on a From Country of Citizenship Citizenship (please check one and provide documentary proof) Country of Citizenship Language normally used at home at time of application (Please specify if more than one.) English French Other First language Other English French B No Yes Concordia I.D. Number Summer/1 Fall/2 Winter/4 20 I am applying to register for the following semester: University / Institute in: Arts Science Commerce Administration Engineering Computer Science Fine Arts Other I am a visiting student from: E-mail: I am a Canadian Citizen Member of the First Nations Permanent Resident Student’s Signature Date I hereby acknowledge that, should I receive authorization fr om Concordia University to register as a Visiting Student, I will be bound by and undertake to observe the statutes, rules, regulations, and policies in place at Concordia University and at the faculty or faculties in which I am registered, including those policies con- tained in the University calendars. I agree to provide information f or the creation or verification and use of a permanent code assigned by the Québec Ministry of Education, of Leisure and Sport. Completed form must include all relevant supporting immigration status documents and letter of permission allowing you to take courses at Concordia University from your home university. My obligations commence with the signing of this agreement and terminate in accordance with the University's statutes, regulations, and policies. I certify that all statements on this application are correct and complete. I understand that my authorization to register or registration is subject to cancellation at the sole discretion of the University. UES410 73100 (7/07) D Quebec Residency — If you are eligible to establish Quebec Residency status please visit the website QuebecResidency.concordia.ca for details.

Visiting Request Form

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Transcript of Visiting Request Form