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* Upload one document at a time, wait for upload to complete before selecting Submit
* Larger files may take longer to upload, please wait
* Documents with multiple pages must be submitted as one file

Citizenship*

Personal Information

Family Name:*
Given Name:*
Birth Date:*
Address:*
Postal/ZipCode:*
City:*
Province/State:
Country:*
Student E-Mail Address:*
Mobile:*
First Language
Street Address in Canada (if available and different from above)

Voluntary Disclosure

*You may voluntarily provide the personal information listed below:

Do you identify yourself as an Aboriginal person, that is, First Nations, Métis, or Inuit?

If you answered “Yes”, please indicate if you are:

First Nations
Métis
Inuit

Do you have a long-term physical or mental health condition that limits the kind of activity that you can perform on a daily basis?

Disability
If yes, are you requesting accomodation?

Status

Immigration Status*
If other - Please specify:

Program

Program:*
Program Schedule(Not Guarantee)
Desired Start Date*
Payment Plan (9month,1 or 2 years program only)
Agency Name
Agent Contact Full Name
Agent Contact E-mail

Please upload the following documents:
1. copy of passport
2. copy of diploma (high school, college or university).
3. Professional English Score(IELTS TOEFL, etc)

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