Applicant Information

By checking this box, you consent to this information being shared with the Province of New Brunswick and IRCC to confirm your identity and verify you are eligible to receive a Provincial Attestation Letter from the Province of New Brunswick.*

Salutation:

First Name:*

Last Name:*

E-Mail:*

Home Phone:*

Mobile:*

English as a Second Language?*

First Language*

Gender*

Birth Date:*

Please upload and attach:

Academic Records

Language Testing

Passport

Student Photo (Shoulder/head shot) for Student Card

Documents

Country:*

International Home Address

Home - Address

Home - City

Home - Province / State

Home - Country

Home - Postal / ZipCode

Emergency Contact/Next of Kin

Emergency Contact: Full name:*

Emergency Contact: Relationship:*

Emergency Contact: Phone #:*

Emergency Contact: Address:*

Program Information

Program of Interest?*

What is your desired start Year and Month.
We will confirm your actual start date based on the registration process completion.

Desired Start Date

Additional Information

High School Grad Date

Higest Level of Completed Education*

By submitting this form, I agree that Atlantic College of Applied Health Sciences may call, text and/or email me about their educational services