Online Application Forms

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Online Application Forms

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general info personal info homestay info academic info payment info * I have read and understood the information page containing the following:

- Academic program description - Application checklist

- Student responsibilities and agreement - Refund policy

- Homestay refunds - Homestay program

General Information

All fields identified by a * must be completed

Student’s Family Name :*

Student’s Given Name :*

Student’s English Name (if any) :

Gender :* Male Female

Date of Birth (day/month/year) :* / 1 - January /

Father’s Family Name :

Father’s Given Name : Father’s Date of Birth

(day/month/year) : / 1 - January /

Father’s Occupation :

Mother’s Family Name :

Mother’s Given Name : Mother’s Date of Birth

(day/month/year) : / 1 - January /

1 - January

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Mother’s Occupation :

Home Address Line 1 :*

Home Address Line 2 :

City :*

Province/State :

Country :* Select Country

Postal Code :

Home Tel :*

Home Fax :

Father’s Work Tel :

Father’s Work Fax :

Mother’s Work Tel :

Mother’s Work Fax :

Email :*

check this if more than one person in a family applying and prefer to use the same email address

Additional Email:

This is: parent's email student's email Login ID:*(6-30 characters)

Password :* (6-20 characters, must contain at least one letter and one number)

Password again to confirm :*

You can use the combination of the login ID and password above to log back in to update your contact info or complete this application if you can not complete all five sections at one time

Emergency Contact Person (other than parents)

Family Name :

First Name :

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Address Line 1 : Address Line 2 : Phone : Fax : Email : Education Goals I am currently in grade :*

and I wish to apply for grade :*

I will be in School for :* One semester One year Longer than one year

I wish to :* Graduate in Manitoba

Develop English skills only When I have completed this

program I intend to :*

Apply to a Canadian/U.S. college or university

Apply to a university or college in my home country

I will not be applying to university or college

Other

I want to begin my studies in :* Semester 1: September – January Semester 2: February – June Preferred start date

(day/month/year) :* / 1 - January /

100-2nd Street South, Box 820, Souris, Manitoba, Canada R0K 2C0 Tel: 204.483.6252 Fax: 204.483.5535

More information email us

1 - January

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Online Application Forms

general info personal info homestay info academic info payment info

Personal Information

All fields identified by a * must be completed

General Info

Do you have any brothers or sisters?*

Yes No If yes, sibling's name

Age

Sex Male Female

Sibling’s Name

Age

Sex Male Female

Sibling’s Name

Age

Sex Male Female

Do you play a musical

instrument? Yes No

If yes, what kind?

Can you read music? Yes No List any pets you have

What are your hobbies and interests?

If you attend church or temple, please indicate type

Describe briefly why you wish to participate in the Study Manitoba International Student Program

Medical Info

Do you have any allergies?* Yes No If yes, please describe

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Do you have any ongoing health

concerns?* Yes No

If yes, please describe

Do you regularly take any

medication?* Yes No

If yes, please describe

Do you smoke cigarettes?* Yes No Additional Info

I have a sibling (brother or sister) currently registered or

applying to attend Study Manitoba International Student Program

Please tell us how you found out about this program: (Check all that apply)

Friend or family member Education Fair

Newspaper or Magazine

Please name publication Canadian Education Centre

Canadian Embassy/Consulate Website

Please name

Other

Please specify if other Name of referring agency, if

applicable

100-2nd Street South, Box 820, Souris, Manitoba, Canada R0K 2C0 Tel: 204.483.6252 Fax: 204.483.5535 More information email us

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Online Application Forms

Homestay Application

All fields identified by a * must be completed Homestay Request

I will require a homestay :*

Yes

No, I have a homestay arranged with : Last Name : First Name : Address Line 1 : Address Line 2 : Postal Code : Relationship to Student : Home Tel : Work Tel : Email : Homestay Information Describe your personality :

Shy Outgoing Organized Disorganized Like to talk Quiet Like to be active Like to study Don’t worry much Easily worried Independent Friendly Family style preferences :

Like small children/babies Don’t like small children

Grandparents in home are okay Single-parent family okay Like pets

No preferences

Like children aged 6-12 Prefer quiet home Prefer active family Prefer no other children Prefer no pets

Prefer other young people Other

Food preferences : Enjoy eating Eat small amounts

Like a big breakfast Like a small breakfast

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Concerned about weight Enjoy Canadian food

Know how to cook Enjoy eating new foods Describe favourite foods :

Describe least favourite foods :

Additional information to help with homestay family selection or school placement :

What hobbies and/or interests would you like to pursue outside of school?

Custodian (Guardian)

Citizenship and Immigration Canada (CIC) requires that each student have a custodian (guardian) in the community. We are willing to accept this responsibility should you wish. Please indicate your preference :*

Yes, I want the Study Manitoba International Student Program to be the custodian for my child.

I have arranged for an adult custodian as follows: check if same as homestay info

Last Name : First Name : Relationship to Student : Address Line 1 : Address Line 2 : Postal Code : Tel : Fax : Email :

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100-2nd Street South, Box 820, Souris, Manitoba, Canada R0K 2C0 Tel: 204.483.6252 Fax: 204.483.5535 More information email us

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Online Application Forms

Academic Information

Please indicate two (2) areas of interest within each category. Every effort will be made to accommodate personal interests. However, we cannot guarantee elective course availability or placement.

Applied Skills Automotives

Clothing and Textiles Cook Training Construction/Woodworking Drafting Electronics Engineering Family Studies Food Studies Home Economics Hospitality/Tourism Mechanics Metalwork Technology Theatre Production Business Education Accounting Business Management Computer Applications Computer Science Data Management Data Processing Entrepreneurship Economics Information Technology Keyboarding Marketing Office Procedures Tourism

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Fine Arts Performing Arts

Band (Concert, Jazz, Marching, Stage, Strings, Orchestra) Choral (Concert, Jazz) Drama/Acting

Dance (General, Choreography, Performance)

Music (Composition, Computer, Contemporary, Electronic) Theatre (Musical, Performance) Visual Arts Art (General) Ceramics Digital Imaging Drawing/Painting Graphic Design Media Studies Photography Sculpture Video Arts Personal Interests

What is your favourite course at school?

Why do you like this course? How long have you studied English?

What sports do you play? Other Information

Is there anything you would like us to know when considering your application?

100-2nd Street South, Box 820, Souris, Manitoba, Canada R0K 2C0 Tel: 204.483.6252 Fax: 204.483.5535

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Online Application Forms

general info personal info homestay info academic info payment info All fields identified by a * must be completed

Payment Information

The $100.00 CAD Application Fee is required at the time of application. Payment Method :*

Credit Card Credit Card Number Visa

MasterCard

Credit Card Expiry

Month Year Name on Card

Cheque or Bank Draft

Make cheques/bank drafts payable to: Study Manitoba

100-2nd Street South, Box 820 Souris, Manitoba, Canada R0K 2C0

Electronic Bank Transfer

Please have fees deposited directly into Study Manitoba bank account:

BANK INFORMATION: Royal Bank of Canada Transit #02737

Bank Account #1006220 SWIFT CODE: ROYCCAT2 BANK ADDRESS: RBC Royal Bank Melita Branch 85 Main Street

Melita, Manitoba R0M 1L0 CANADA

*By checking this box, I confirm that I have read and understood the Refund Policy and agree to the Terms and Conditions. I also confirm that I have read and understood the Privacy Policy.

Required Supporting Documents

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documents are required: Recent photo Final transcript

Copy of first page of passport

Please indicate method you will use to submit these documents to our office Attached Fax Mail Courier Other (specify below)

Click the button below to submit payment after uploading the documents

100-2nd Street South, Box 820, Souris, Manitoba, Canada R0K 2C0 Tel: 204.483.6252 Fax: 204.483.5535 More information email us

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