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1 Online Application Forms here Already registered? Login know. Having trouble using the online form? Click here to let us 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 /

2 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 : * check this if more than one person in a family applying and prefer to use the same address Additional This is: parent's student's 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 :

3 Address Line 1 : Address Line 2 : Phone : Fax : 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 / 1 - January / (day/month/year) :* Study Manitoba International Student Program nd Street South, Box 820, Souris, Manitoba, Canada R0K 2C0 Tel: Fax: More information us

4 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?* If yes, sibling's name Age Yes No 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

5 Do you have any ongoing health concerns?* If yes, please describe Yes No Do you regularly take any medication?* If yes, please describe Yes No 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 Study Manitoba International Student Program nd Street South, Box 820, Souris, Manitoba, Canada R0K 2C0 Tel: Fax: More information us

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7 Online Application Forms general info personal info homestay info academic info payment info 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 : Homestay Information Describe your personality : Shy Outgoing Organized Disorganized Like to talk Quiet 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 Other Food preferences : Enjoy eating Eat small amounts Like to be active Like to study Don t worry much Easily worried Independent Friendly Like children aged 6-12 Prefer quiet home Prefer active family Prefer no other children Prefer no pets Prefer other young people Like a big breakfast Like a small breakfast

8 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 : Study Manitoba International Student Program

9 100-2nd Street South, Box 820, Souris, Manitoba, Canada R0K 2C0 Tel: Fax: More information us

10 Online Application Forms general info personal info homestay info academic info payment info 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

11 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? Study Manitoba International Student Program nd Street South, Box 820, Souris, Manitoba, Canada R0K 2C0 Tel: Fax:

12 More information us

13 Online Application Forms general info personal info homestay info academic info payment info All fields identified by a * must be completed Payment Information The $ CAD Application Fee is required at the time of application. Payment Method :* Credit Card Visa MasterCard Credit Card Number Credit Card Expiry Month Name on Card Year Cheque or Bank Draft Electronic Bank Transfer Make cheques/bank drafts payable to: Study Manitoba 100-2nd Street South, Box 820 Souris, Manitoba, Canada R0K 2C0 Please have fees deposited directly into Study Manitoba bank account: BANK INFORMATION: Royal Bank of Canada Transit #02737 Bank Account # 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 In addition to the application and application fee, the following

14 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 Study Manitoba International Student Program nd Street South, Box 820, Souris, Manitoba, Canada R0K 2C0 Tel: Fax: More information us

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