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| New Student: ______ | From UCEP: ___ | Re-enrollment: ___ | Priority: ___ |
| Band Code: _______ | Family #: ______ | Position#: ______ | |
| Application Date (Y/M/D): ___/___/___ | Date of Birth (Y/M/D): ___/___/___ | ||
BASIC STUDENT INFORMATION
| Surname: __________________________________ | Give Name: ________________ | Phone: __________________ | |
| Address: __________________________________ | Province: _________________ | Postal Code: _____________ | |
| Sex - Male: ____ Female:_____ | Dependents: ____________ | Canadian Residence:
Yes: __ No: __ |
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| Previous Units Completed:
UCEP: __ _ Level 1: ___ Level 2: ___ Level 3:___ |
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EDUCATION PLAN
| Attendance:
Full-Time: ___ Part-Time: ___ |
Type of Program:
Community College: ___ Univ. Diploma: ___ B.A.: ___ M.A.: ___ PHD.: ___ |
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| Programme/Course:
__________________________ |
Institution:
__________________________ |
Location with Postal Code:
_____________________________ |
| Length of Program: _______ | Year of Study: _____________ | Date of Gradation (Y/M/D): ___/___/___ |
ESTIMATED COSTS - For Office Use Only
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Fiscal Year |
20__/__ |
20__ /__ |
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| Total Support Costs | ||
| Total Costs | ||
| Student Month |
| Student Signature: _________________________________________________ | Date: ____________________ |
Post Secondary Administrator's Comments
| Recommended: ___ Not Recommended: ___ | Date: _________________ |
| Post Secondary Administrator's Signature: _____________________________________________________ | |
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