Application for study permit

Personal Details

Sex

Full Name

Date of birth

Place of birth

Current country

Spouse's fullname

Country where applying

Current marital status

Native language

Can you communicate in English?

In which language are you most good at?

Have you taken a test from a designated testing agency to access your proficiency in English?

Passport

Passport number

Country of issue

Issue date

Expiry date

National identity document

Do you have a national identity document?

Document number

Country of issue

Issue date

Expiry date

US PR card

Are you a lawful permanent resident of the United States with a valid alien registration card (Green card)?

Document number

Expiry Date

Contact Information

Current mailing address

Street name include your Apt No

City/Town

Province/State

Postal code

District

Country or territory

Email address

Residential address

Street name

City/Town

Province/State

Postal code

Country or territory

Telephone number

Alternative telephone number

Fax number

Details of intended study in your destination

I have been accepted by the following educational institution (original acceptance letter will be required)

Name of school

My level of study will be

My field of study will be?

Designated learning instituition

My student ID

Duration of expected study

The cost of my studies will be...

Funds available for my stay

My expenses in my destination country will be paid by?

Education

Have you had any post secondary education (including university, colege or apprenticeship training)?.. If yes, give full details of your highest level of post secondary education below:

School/Facility name

Date

Field and level of study

City/Town

Country or Territory

Province/State

Employment

Give details of your employment for the past 10 years, including if have held any government positions (such as civil servant, judge, police officer, mayor, member of parliament, hospital administrator)

Date

Current Activity/Occupation

Company/Employer/Facility name

City/Town

Country or Territory

Province/State

Date

Current Activity/Occupation

Company/Employer/Facility name

City/Town

Country or Territory

Province/State

Date

Current Activity/Occupation

Company/Employer/Facility name

City/Town

Country or Territory

Province/State

Background Information

You must complete this section if you are 18 years of age or older

(a) Within the past two years, have you or a family memeber had a tuberculosis of the lungs or been in close contact with a person with tuberculosis?

(b) Do you have any physical or mental disorder that would require social and/or health services, other than medication, during a stay in your destination country?

If you answered yes to question (1a) or (1b) above, please provide the full details and the name of the family member (if applicable)

(a) Have you ever remained beyond the validity of your status, attended school without authorization or worked without authorization in destination country?

(b) Have you ever been refused a visa or permit, denied entry or ordered to leave your destination country or any other country or territory?

If you answred yes to question (2a), (2b), or (2c), please provide details

(a) Have you ever committed, been arrested for, or been charged with or convicted of any criminal offence in any country or territory?

(b) If you answered yes to question (3a) above, please provide full details

(a) Did you serve in any military, militia, or civil defence unit or serve in a security organization or police force (including non obligatory national service, reserve or volunteer units)?

If you answered yes to question (4a) above, please provide dates of service and countries or territories where you served.

Are you, or have you ever been a member or associated with any political party, or other group or organization which has been engaged in or advocated violence as a means to achieving a political or religious objective, or which has been associated with criminal activity at any time?

Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or desecration of religious buildings?

Certification/Acceptance

CIC may want to contact you in the future to ask you about any services you received from A3 Immigration Inc. prior to the application process (such as participation in an information forum), during the application process (including the application process itself as well as orientation or accreditation services), and services received after arriving at your designated country (including settlement, integration and citizenship). A3 Immigration Inc. will not use this information to make decisions about you personally.

Do you consent to be contacted by CIC, or an organization at CIC's request?

I declare that I have answered all questions in this application fully and truthfuly

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Personal Details

Passport

National identity document

US PR card

Contact Information

Details of intended study in your destination

Education

Employment

Background Information

Certification/Acceptance

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