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APPLICANT INFORMATION

First Name:
Middle Name:
Last Name:
Birth Date MM/DD/YYYY:
Address:
City:
Province:
Postal Code:
Cell Phone:
Home Phone:
Email:

EMERGENCY CONTACT PERSON

First Name:
Last Name:
Phone Number:
Relation To You:
Parent Friend Spouse Other
HOW DID YOU HEAR ABOUT THE PROGRAM?
Online Agency Friend Graduate

IF YOU WERE REFERRED BY A GRADUATE OR CURRENT STUDENT PLEASE PROVIDE THEIR FULL NAME AND TELEPHONE NUMBER:

First Name:
Last Name:
Phone Number:

EDUCATION

Have You Achieved Your High School Diploma Or Equivalency?:
YES NO
What Is Your Highest Level Of Education? (Example: Bachelor Degree Or Certificates In What Field)

RESIDENCY

HAVE YOU RESIDED IN ALBERTA FOR THE LAST 12 MONTHS?:
YES NO
If not, have you lived in a different province prior to Alberta?
YES NO
Are you a:
Canadian Citizen Permanent Resident Protected Person Student Visa
When did you enter Canada?
ARE YOU CURRENTLY ON (PLEASE SELECT IF APPLICABLE):
Regular Employment Insurance (EI) benefits Assured Income for the Severely Handicapped
Special, Medical, or Maternity Employment Insurance (EI) benefits Workers’ Compensation Board

FORMER STUDENT AID

Have you ever received student loan(s) (Provincial or Federal) in the past?
YES NO
Is the student loan currently paid off or in good repayment standing?
YES NO
Have you been in any type of training in the past 12 months?
YES NO
If Yes, What Was The Name Of The Program?
Educational Institution Name:

PROGRAM OF INTEREST

Program of Interest
Administrative Professional Business Administration Legal Administrative Assistant
Logistics and Supply Chain Management Educational Assistant Accounting Essentials - Short Training Program
Campbell College is committed to safeguarding the personal information entrusted to us by our clients.
By providing this information, I consent to Campbell College’s use of my personal information in accordance with Alberta’s Personal Information Protection Act (PIPA) and other applicable laws required for the purpose of registration and enrolment into all our courses and programs licensed under the Private Vocational Training Act and Regulation.
I certify the information I have provided is accurate and complete to the best of my knowledge and I authorize verification if necessary.
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