High School Application

(Grade 9 -12 Form)

Student Personal Information
Legal Name * : (Family)    (Given)    (Middle)
Preferred Name:
(if different)
Sex:        
Nationality(ies):    
Application for Grade:            
Address:
           
Current Contact Address:
(if different from above)
                  
Student Educational History
GradeName of SchoolAddressPeriod of AttendanceReason for Leaving
English language ability:               TOEFL Scores:     
Complete name, address, and phone/fax/e-mail of school last attended (required):
Address:
                  
Was your child in any of the following programs? (if ticked please provide details of the program on a separate sheet)
Interests/hobbies:
Family Information
Mother/First Parent/Guardian
Name:(family) (given)
Nationality(ies):
Home Language:
Employer:
Position:
Work (Phone):(fax)
E-mail or other contact:
Father/First Parent/Guardian
Name:(family) (given)
Nationality(ies):
Home Language:
Employer:
Position:
Work (Phone):(fax)
E-mail or other contact:
Family’s permanent address:
Any family members who have attended Canadian International Academy of Business & Technology:
Medical Information
Doctor Name: Phone No.:
Is your child on Medical Condition?   
Please provide a Doctor’s Medical Note and explain:
  
Does your child suffer from a condition that could cause anaphylactic shock?   
Please provide a Doctor’s Medical Note and explain:
  
Emergency Contact (other than parent)
Emergency contact 1: Name: Phone:
Emergency contact 2: Name: Phone:
(it is the parent’s/student’s (ago over 18) responsibility to ensure that the emergency information is correct)
Payment Information
Methods of Payment (check one):               

Non-refundable application fee of CAD$500.00 must be sent with this form. Make drafts payable to Canadian International Academy of Business & Technology.

Please use the following banking information for fund transferring:

Credit Account of: Canadian International Academy of Business & Technology
TD Canada Trust
Golden Square Centre, 1177 Central Parkway West,
Mississauga, Ontario, L5C 4P3, Canada

Canadian Account: Transit No:    18682-004
Account:    1868-5205428
Tel No:    905-896-3188
Fax No:    905-896-3911

U.S. Account: Transit No:     18682-004
Account:     1868-7304668


Swift Code: TDOMCATTTOR