New Student Application
General Information

Campus
First Name
Middle Name
Last Name
Birth Date
Gender Male Female
Marital StatusSingle
Married
  (Required)
Address
Apt.
City
State/Province
Zip/Postcode
Country
Home Phone
Cell Phone
Email
Citizenship  (Required)
What is your status in Canada?Citizen
International Citizen
Landed Immigrant

Program


Permanent Contact Information

If different from above

Address
Apt
City
State/Province
Zip/Postcode
Country
Phone
Cell or Business phone


Emergency Contact Information

Contact Name
Relationship
Home Phone
Work Phone
Cell Phone


Additional Information
How did you hear about Sacred Heart?
(Please rate the top three influences on your decision to apply to Sacred Heart)
ChurchYes    No    Not Selected
Parent or GuardiansYes    No    Not Selected
FamilyYes    No    Not Selected
AdvertisementYes    No    Not Selected
Sacred Heart WebsiteYes    No    Not Selected
Current studentYes    No    Not Selected
If yes, Pleace Specify
OtherYes    No    Not Selected
If yes, Pleace Specify

Academic History

What high school did you graduate from?  (Required)
High School Name
Location (City, Country)  (Required)
Diploma/Certificate Completed/ In progress  (Required)
Dates Attended  (Required)
Have you attended University or College after high school?Yes    No    Not Selected  (Required)
If yes, Please specify Name
College/University Name
Location (City, Country)
Diploma/Certificate Completed/ In progress
Dates Attended
College/University Name
Location( City, Country)
Diploma/Certificate Completed/ In progress
Dates Attended From

English Language Proficiency

What is your native language/mother tongue?  (Required)
Have you studied in English (ESL excluded) at an English speaking institution for a minimum of 3 years?Yes    No    Not Selected
If yes, please check at which institution:High School
University
College
Other

If other, Please Specify

Signature

I declare that I am the applicant and the information I have submitted in this application is true, correct, and complete to the best of my knowledge. This signed application permits Sacred Heart of Peterborough to request and/or confirm information on this application and supporting documentation submitted. The falsifying or withholding of documents or information will result in immediate and permanent cancellation of admission or registration to Sacred Heart of Peterborough. I have read and understood the Declaration in the above statement.

Signature of the Applicant  (Required)
Please Type Full Name
Date  (Required)



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