Untitled - Yukon College

student information
Application for Admission
Please submit your application with the non-refundable CAN$20 application fee to:
Admissions Office
Box 2799, 500 College Drive
For administrative use only:
CAN$20 APPL. PAID? □ YES □ NO
Whitehorse, YT Y1A 5K4
ID#: ________________________
Yukon College Program
Program Name (per Yukon College Calendar) Term/Year □ Full-time
□ Part-time
Personal Data (please print clearly)
Legal Last Name First Name Middle Name
Gender □ Male □ Female Former Last Name
Mailing Address
Telephone Number (Work)
City/Province Postal Code Telephone Number (Home)
Email Address
Social Insurance Number
(Required to receive a T2202A tax form)
Do you consider yourself to be of First Nations Ancestry?
□ Yes □ No If yes, which First Nation:
Birth date (Day/Month/Year)
Citizenship Status:
□ Canadian or Permanent
Resident
□ Non-Resident
Educational Background (attach official transcripts)
Name of Secondary School Last Attended Highest Grade Completed Dates Attended Location
Post Secondary Education Degree Earned Dates Attended Location
Application Declaration
I DECLARE THAT THE INFORMATION GIVEN IN THIS APPLICATION IS COMPLETE AND CORRECT AND I
UNDERSTAND THAT MY APPLICATION WILL NOT BE PROCESSED UNTIL THE CAN$20 APPLICATION FEE IS PAID.
_______________________________________
Signature of Applicant
____________________________
Date
10 www.yukoncollege.yk.ca
Ayamdigut Campus toll free: 1.800.661.0504 Admissions: 867.668.8710 Yukon College 2012/13