First Name:*

Middle Name:

Last Name:*

Preferred Name:

Mobile:*

Home Phone:*

E-Mail:*

Birth Date:*

Gender

Postal/ZipCode:*

Address1:*

City:*

Province/State:*

Country:*

Emergency Contact Telephone*

Emergency Contact Name*

Emergency Contact Relationship*

Are you a Canadian Citizen?*

Social Insurance Number (Canadian Students Only)

If you are not, what is your citizenship?*

Do you have a study permit?

If you do not have a study permit, do you have a permit, visa or other written authorization to study in Canada other than a study permit?

Is English your first language?

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

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?

How did you find out about the Program and/or Granville College? (Part 1):*

Please Specify (Part2):*

What interests you most about the Program you are applying for?

What motivates you to complete this program of study?

List any challenges you feel you may have or face in this program of study.

Please list any medical conditions which could cause obstacles for you to complete this program or for which you may need some further assistance (physically or emotionally).

/month

/week

Are you a high school graduate?

Name Of High School:

High School Grad Date

Level of Education

PEN

Have you attended University, College or a vocational Program?

Name of Institution

Program of Study

Level/Year completed

Are you currently employed?

Name of Employer:

Position:

How many hours per week will you be working while you study?

Are you eligible to receive funding from any source?

If yes, please describe:

Program Category:

Program:

Desired Start:*

What motivates you to work in the field of animal health care?

Do you own any animals?

If yes, please list:

All students are required to participate in animal restrain classes during which they will be required to lift a large dog from the floor onto a table. Do you have any medical disability that would prevent you from doing so?

If yes, please list:

Ethical concerns regarding animals are often discussed in class. Such topics include cat declawing, breeding, and euthanasia. As a student in practicum or as a working Veterinary Technician Assistant, there may be times when you are asked to assist in a procedure you personally oppose. How would you manage this:

Working in the animal health care field is as rewarding as it is challenging. As a Veterinary Technician Assistant you will be able to help grieving clients and help Animals who have been abused. You may become attached to certain animal patients who pass on and could witness an animal’s passing passing yourself. How would you manage this?

What duties do you believe a graduate of this program would perform in an animal health care setting.