Account Manager: ___________________________ Arbutus Student Number:______________________

DLI#O19219834012
Proposal Number: _____________________

ADMISSIONS APPLICATION 2017

Please complete this form by typing.
REQUIREMENTS & DOCUMENTS CHECKLIST

Application form (Please type this form) Payment Plan:

$200 Application Fee (non-refundable) YES NO
Passport (Copy of page with picture)
High school or post-secondary certificate or transcript Promotion Code:
Official English Score as required by your chosen program

PROGRAM CHOICE

ACE (English Program): Academic Term: months English Program Start Date:

Career Program: Career Program Start Date:

Academic Term: months Co-op Term: months

APPLICANT INFORMATION

Full Name:
First Last Nickname
Birthdate (DOB): Gender: female male

Address:
Apartment/Unit # Street Address

City Province Country ZIP Code

Skype: Email Phone:

EDUCATION

High School/College/Other: City: Country:

YES NO
From: To: Did you graduate? Highest achievement:

IELTS score: Other:

AGENT INFORMATION

Agent Name: Email:

Agency: Phone:

Address: YES NO
Does the agency require an agent quote?

PAYMENT
I would like my payment to be made:
Bank name: RBC Royal Bank Of Canada (Hastings & Granville Branch) 685
Bank Address: West Hastings St, Vancouver, B.C., V6B1N9
Directly to the College OR through my agency Account Name: Arbutus College of Communication Arts, Business & Technology
Transit: 06550 Institution: 003 Account: 1043066 Swift Code: ROYCCAT2
Comment :

All payments may be made by bank transfer, credit card or International money order.If paying by money order add an additional fee of $30 and send a payment proof
to payments@arbutuscollege.com; be certain to include the student's full name.

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.

Signature: Date: