Admission Assessment Form

Personal Information

Prefix

First Name *

Middle Name

Last Name*

Previous Last Name (if changed)

Birthday *

SPP Applicant *

Yes

No

Do you have valid study permit? *

Yes

No

Cambrian Student ID Number (if available)

Citizenship *

Passport Number

Native Language*

While in Canada where will you stay?

Homestay (host family)

Private Residence (appartment, house, etc.)

Applicant's Contact Information

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone Number

Email *

Confirm Email *

English Scores (IELTS)

Listening

Reading

Writing

Speaking

Program Information

Campus *

Program *

Starting Term *

Emergency Contact

Cannot be agent information. Overseas emergency contact is acceptable

Emergency Contact Name *

Relationship

Street Address

Apartment, suite, etc

City

State/Province

ZIP/Postal Code

Country

Phone Number

Email *

Agency Information

If applying through a registered agent of Cambrian College or of Cambrian @ Hanson International Academy

Agency

Agency ID

Contact Person

Email Address

Student Consent

I certify that the above information is true and complete. I understand that any false or incomplete information that is submitted in support of my application may invalidate my application. I have read the Freedom of Information and Protection of Individual Privacy Statement. I authorize Hanson International to ineract/exchange information with my agent with respect to my admission to Cambrian College programs at Hanson International.

I authorize Cambrian at Hanson to use my contact information

Student Identification Agent Authorization : this form must be filled out at the time of application authorizing the student to be represented by an agent. Students who do not authorize agent representation will not be eligible as an agent claim. Agents who claim students who have not authorized their representation will not be paid commission. Students who “shift” agents must sign a new authorization letter and ensure their previous agent is notified and have initialized the form below. Section One: Student Identification

Student Name

Date of Birth

Country of Citizenship

Immigration Status in Canada

Section Two: Previous Academic History Only for students who are on Study Permit

What College's Offer Letter was used to receive Study Permit

Date of Arrival in Canada

Section Three: Authorization Acknowledgement

By adding my name below I authorize the Agent/Agency listed below to act as my representative throughout my application process to Hanson Cambrian and Hanson International Academy.

Please list your agent/agency

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