Applicant - Personal Information

First Name:*
Last Name:*
Telephone:*
Mobile:
Email:*
Citizenship*
Date of Birth:*
Are you a Canadian Permanent Resident?
Desired Start Date

Address - Country of Origin

Address1:*
Address2:
City:*
Province/State:*
Country:*
Postal/ZipCode:*

Current Address(If different from country of origin address)

Same as Country of Origin*
Address in Country of Residence*
City
Province/State/Region

Next of Kin Information

Next of Kin: Full Name*
Next of Kin: Relationship
Next of Kin: Address
Next of Kin: City*
Next of Kin: Province/State
Next of Kin: Postal/ZipCode
Next of Kin: Country*
Next of Kin: Phone Number*

International Agent - Primary Contact Information (if Applicable)

First Name
Last Name
Email
Rep
Telephone

Previous Education

High School Grad Date*
Name of High School*
Higest Level of Education Completed*
Program Name
Institution Name
Program Completion Date

English Language Proficiency

Date of PELMO test*
PELMO PCA assessment score*

Employment Background

Please briefly describe any previous work experience you may have

Volunteer Experience

Please list the volunteer experience and service hours you have. This may include community agencies, school programs, etc*

Additional Information

Please briefly describe the reasons for your interest in the International PCA Program
Are you interested pursuing permanent residency in Canada?
If yes, please provide details such as family members that may accompany you so that we may provide you with appropriate support services and information on living in Canada

  • Student Declaration

    Upon submitting this information, I declare that the information contained is complete and accurate. 

 

Upon submitting this information, I declare that the information contained is complete and accurate. In submitting this application, I agree to be bound by the policies, rules and regulations set forth by the Centre for Nursing Studies and Keyin College and that the above information is complete and accurate.

Required Attachments/Supporting Documents

1. Copy of photo and signature pages of your passport

2. High School Trasncript and Diploma

3. University/College Transcript and Diploma (if applicable)

4. Two (2) reference letters

5. Volunteer verification

Attach Required Documents*
  

Program Information

By submitting this form, I agree that Keyin College may call, text and/or email me about their educational services