First Name / Given Name:*
Last Name / Family Name:*
Street Address / PO Box No.:*
Province / State:*
Best way to contact you:*
Date of Birth*
Select Start Date*
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
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?
Are you still attending High School?*
Did you graduate from High School?
High School Grad Date
Have you completed a GED or equivalent? *
Do you need help with Health and Travel insurance?*
Do you have accommodations in Moncton?*
Do you wish to attach additional application documents at this time that are required to complete the application?
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.