ADMISSION FORMpage 1 of 4 REG-100a-AD (01-21)

Bureau du registraire

Please write for which term you wish to submit an admission application : Winter 20_______ Summer 20_______ Fall 20_______

Write your Student ID Number (NI) :

Have you already submitted an admission application, by printed or electronic form, for the requested term? Yes No

ADMISSION PROFILEPersonal data2 FIRST NAME LAST NAME DATE OF BIRTH (YYYY-MM-DD)

QUEBEC GOVERNMENT PERMANENT CODE GENDER 3 MOTHER TONGUE 4 LANGUAGE SPOKEN AT HOME Female Male French English Other French English Other

5 COUNTRY OF BIRTH PROVINCE/STATE OF BIRTH CITY OF BIRTH

6 I am a member of Canadian First Nations : Yes No

Contact detailsPersonal address

7 ADDRESS

COUNTRY PROVINCE/STATE CITY POSTAL CODE

Telephone8 COUNTRY OF THE PHONE NUMBER PHONE NUMBER EXTENTION

Personal e-mail address (Mandatory for the treatment of an admission application)9 E-MAIL

Names of parents10 FIRST PARENT FIRST NAME LAST NAME AT BIRTH

Mother Father

SECOND PARENT FIRST NAME LAST NAME AT BIRTH

Mother Father

ADDITIONAL INFORMATIONLegal status11 Current legal status in Canada : Canadian citizen born in Canada Permanent resident in Canada Foreign Canadian citizen born outside Canada

Pre-university studies12 I did all my elementary studies in French : Yes No I did all my secondary studies in French : Yes No

13 I obtained at least or I will obtain :A. a Diploma of College Studies (DCS) issued by the government of Québec : Yes NoB. a pre-university studies diploma issued outside of the province of Québec or Canada : Yes No

1

T 418 656-3080Fax: 418 656-5216reg@reg.ulaval.careg.ulaval.ca

Pavillon Jean-Charles-Bonenfant2345 allée des BibliothèquesRoom 2440Québec City (Québec) G1V 0A6CANADA

ADMISSION FORM

THE PAYMENT OF THE ADMISSION FEES IS REQUIRED for the application to be processed. A maximum fee of $89,50 (CAD) applies to the filing of your admission application. You can submit your admission application by email at reg@reg.ulaval.ca or by mail at the above-mentioned address.

IMPORTANT

Secteur

__________

Please save this form on your computer and then complete it with Acrobat Reader. Do not complete directly in your browser.

REG-100a-AD (01-21)

University studies14 I am studying or I have studied :

A. at Université Laval : Yes NoB. in a Québec university other than Université Laval : Yes NoC. in a univesity outside of the province of Québec or Canada : Yes No

DATE (YYYY-MM-DD)I started my university studies on :

15 I completed 12 university credits or more, except for language courses or qualifying courses (pre-university courses) : Yes No

DETAIL OF PAST AND CURRENT STUDIESDirective16 Write your past and current studies

• Pre-university studies outside of the province of Québec or Canada only• College studies at Collège Stanislas or Collège international Marie de France only• University studies other than those done at Université Laval

A COUNTRY STATE/PROVINCE

EDUCATIONAL ESTABLISHMENT

TYPE OF TRAINING (EX: BACHELOR’S DEGREE, MASTER’S DEGREE) STUDY PROGRAM (EX: LAW, COMPUTER SCIENCE)

STATE OF PROGRESS : START DATE (YYYY-MM) END DATE (YYYY-MM)

Forsaken Undergoing Completed

B COUNTRY STATE/PROVINCE

EDUCATIONAL ESTABLISHMENT

TYPE OF TRAINING (EX: BACHELOR’S DEGREE, MASTER’S DEGREE) STUDY PROGRAM (EX: LAW, COMPUTER SCIENCE)

STATE OF PROGRESS : START DATE (YYYY-MM) END DATE (YYYY-MM)

Forsaken Undergoing Completed

C COUNTRY STATE/PROVINCE

EDUCATIONAL ESTABLISHMENT

TYPE OF TRAINING (EX: BACHELOR’S DEGREE, MASTER’S DEGREE) STUDY PROGRAM (EX: LAW, COMPUTER SCIENCE)

STATE OF PROGRESS : START DATE (YYYY-MM) END DATE (YYYY-MM)

Forsaken Undergoing Completed

Considering the guidelines written above, I confirm that I have declared all my past and current studies and that the information given is accurate.

Code d’établissement

______________________

Type de formation

______________________

Code d’établissement

______________________

Type de formation

______________________

Code d’établissement

______________________

Type de formation

______________________

ADMISSION REQUESTChoice of study program(s)

17 CHOICE OF PROGRAM Programme Majeure

Site

Campus

ADMISSION FORMpage 2 of 4

REG-100a-AD (01-21)

NOTICE AND CONSENT

I pledge that the information given in this admission application is complete and accurate.

By submitting this admission application, I agree that the information mentioned in it may be used for evaluation purposes by Université Laval and kept for the timenecessary for the completion of the purpose they were asked for.

I also authorize the use of this information by the University, if necessary, for the administration of my student file and the different services related to my studies,student life and community life at the University.

I also authorize Université Laval and the Québec ministry responsible of high education to pass on information necessary for :• The evaluation of my admission request• The creation, validation and correction, if necessary, of my permanent code.• The calculation of the subsidy given to Université Laval and collection of statistics data, in case of a registration.

If necessary, I also authorize Université Laval and the Québec ministry responsible of immigration and the corresponding Canadian ministry to pass on necessary information for :• The confirmation of my temporary residence status• The confirmation of my University student status

Université Laval ensures the protection of the personal information and the confidentiality of its members. The relation between Université Laval and you is ruled by the Quebec and Canada law that apply in Québec. For more details about confidentiality of information and access requests, consult the page Confidentialité (French only) on monPortail.

Consent

By checking I read and I agree, you consent to the collection, use, disclosure and communication of personal information mentioned as explained above. Likewise, you declare that the personal information and documents provided on admission, as well as in any other future transaction for the purpose of validating your identity or legal status, are accurate and meet requirements.

I read and I agree

SIGNATURE DATE (YYYY-MM-DD)

RÉSERVÉ AU REGISTRAIRE

MONTANT À PAYER PAIEMENT ANALYSE DU DOSSIER

Complet Incomplet Exemption En attente du paiement complet À analyser immédiatement

PAR (INITIALES DE L’AGENTE) DATE (DATE DE CODIFICATION)

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ADMISSION FORMpage 3 of 4

Specific questions Certificate18 If you chose a certificate program, do you intend to integrate it into a multidisciplinary B. A.? Yes No

Non-degree studies19 If you submit an admission request for non-degree studies, please write the level of studies :

Pre-university level (qualifying courses) Undergraduate Graduate PostgraduatePlease specify the intended program, if applicable :

__________________________________________________________________________________________________________________________________________________________________________ Not applicable

Graduate studies20 Which field of research are you interested in?

__________________________________________________________________________________________________________________________________________________________________________ Not applicable

21 Has a faculty member at Université Laval agreed to direct your research? Yes No Not applicable

If so, indicate name and faculty : _____________________________________________________________________________________________________________________________________________________________

22 Have you received or are you expecting to receive a scholarship? Yes No Not applicable

If so, please state from which organization : ____________________________________________________________________________________________________________________________________________

REG-100a-AD (01-21)ADMISSION FORM

page 4 of 4

SPECIFIC INDICATIONS FOR COMPLETING THE APPLICATION FORM

Indications below refer to the numbered sections of the admission form. It is important to read each of these indications before completing the sections.

SECTION 1 If you know your Student ID Number (NI) at Université Laval, please indicate it.

SECTION 2 A Québec applicant married before April 2, 1981, and wishing to keep using her husband’s name must complete this question as follows: indicate her last name at birth followed by her husband’s last name. For all other applicants, only the last name at birth should be used.

The permanent code is given by the Government of Quebec and is used to identify yourself all through your studies. It is written on some official documents such as college studies reports and university transcripts. The permanent code contains four letters and eight numbers.

SECTION 3 Indicate the first language learned and still understood.

SECTION 4 Indicate the language most often spoken in your current home.

SECTION 6 Some programs with quotas might have reserved places for Canadian First Nations applicants.

SECTION 9 It is mandatory to indicate a valid e-mail address for the treatment of an admission application.

SECTION 11 The Canadian citizens born in Canada status corresponds to applicants who have:• A birth certificate from Canada

The Canadian citizens born outside Canada status corresponds to applicants who have:• A Canadian citizenship certificate* or• A Canadian citizenship card*

* A copy of the Certifcat de sélection du Québec (CSQ – Québec Selection Certificate) must accompany the application for admission, where applicable.

The Permanent resident status corresponds to applicants who have :• A Record of Landing (IMM 1000, IMM 5292 or IMM 5688)* or• A Permanent Resident Card*

* A copy of the Certifcat de sélection du Québec (CSQ – Québec Selection Certificate) must accompany the application for admission, where applicable.

The foreign status corresponds to any person holding a citizenship other than Canadian, including any person in process of becoming a permanent resident, any person demanding the status of refugee in Canada and any person recognized as a refugee by Canadian federal authorities.

SECTION 13 If you hold or will be holding an Attestation of College Studies (ACS) only, you must answer no to this question.

SECTION 14 You must answer Yes to this question if you were already enrolled in :

• a regular study program• pre-university courses (qualifying courses)• courses as an extramural or audit-only student• continuing education courses• distance education courses

The non-credited continuing education (ex.: MOOC) is excluded from university studies

SECTION 17 Please ensure that the programs selected accept new applicants in the term requested ; for information, refer to this site : www2.ulaval.ca/les-etudes.html.

It is not compulsory to indicate a second choice for a program. If you do so, all of your choices will be processed simultaneously. You cannot indicate more than two choices of limited enrolment program.

SECTION 18 The multidisciplinary bachelor’s degree is for candidates who are interested in many subjects and wish to obtain a coherent and customized education or wish to broaden their horizons and get ready for the labour market. The multidisciplinary bachelor’s degree can be made of either three certificates or two certificates and complementary skills. (https://www.ulaval.ca/les-etudes/programmes/repertoire/details/baccalaureat-multidisciplinaire-ba.html).

https://www.ulaval.ca/les-etudes.htmlhttps://www.ulaval.ca/les-etudes/programmes/repertoire/details/baccalaureat-multidisciplinaire-ba.html

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