Personal Information

Salutation:
Gender Pronoun
First Name / Given Name:*
Last Name / Family Name:*
Street Address / PO Box No.:*
Address2:
City:*
Province / State:*
Postal / ZipCode:*
Country:*
Main Phone:*
Mobile:*
WhatsApp Address
E-Mail:*
Best way to contact you:*
Date of Birth*

Program of Interest

Program Category:
Program:*
Select Start Date*

Citizenship Information

Are you a Canadian Citizen?*
Country of Origin
Do you currently have a valid Visa/Permit to visit, work or study in Canada?
Are you currently in Canada?
Do you have a Passport?
Passport Country of Issue
Passport Number:

English Proficiency

What is your first language?
Have you completed an official English Language Proficiency test?
Can we send you an English test?
Why are you improving your English?

Current/Previous Education

High School Name*
High School Location:*
Are you still attending High School?*
Did you graduate from High School?
High School Grad Date
Have you completed a GED or equivalent? *
List all post-secondary institutions with location and program/degree

Related Information

Do you need help with Health and Travel insurance?*
How did you hear about McKenzie College?*
Please Specify:*
Do you have accommodations in Moncton?*
If McKenzie College was referred to you by someone, please type their name here:

Do you wish to attach additional application documents at this time that are required to complete the application?

Documents
  

Before submitting, be sure the information you have provided is correct and accurate.

By submitting this form, I agree that McKenzie College may call, text and/or email me.