seneca please print, fill out, sign and return pages 1 and 2 via email (november 2014)
DESCRIPTION
Seneca College ApplicationTRANSCRIPT
Page 1 of 2
Applying to Seneca College
Mr. Mrs. Ms. Female Male
Permanent Mailing Address
Last Name: ______________________________________________________________
First Name: ______________________________________________________________
Street: __________________________________________________________________
City: __________________________________ Parish: __________________________
Country: Jamaica
Telephone
Country Code: 1 City Code: 876 Number:__________________________________
Cellular:_________________________________________________________________
Agent Email Address: [email protected]
Email Address: _____________________________________________________________
Birth Date: Month _______________________ Day _________ Year __________
Country of Citizenship: Jamaica First Language: √ English
Basis for admission consideration
□ Secondary school graduate or equivalent (CXC: CSEC, GCE, and/or CAPE) OR
□ College/University Studies (Bachelor Degree and/or Three-Year Diploma)
Page 2 of 2
Program Selection
1. Program: __________________________________________________________
Start Date: □ September □ January □ May
2. Program: __________________________________________________________
Start Date: □ September □ January □ May
Authorization
I certify that the above information is true and complete. I understand that any false or
incomplete information submitted in support of my application may invalidate my application. I
have read the Freedom of Information and Protection of Individual Privacy Statement (See
Below).
Freedom of Information and Protection of Individual Privacy Act: The information on this form
is collected under the legal authority of the Ministry of Colleges and Universities Act, R.S.O.
1980, Chapter 272, S.S.,: R.R.O. 1980, Regulation 640. The information is used for
administration and statistical purposes of Seneca College and/or the Ministries and Agencies of
the Government of Ontario and the Government of Canada. Information Release
Pursuant to the Freedom and Protection of Individual Privacy Act, I hereby authorize Seneca
College to release any and all information related to any and all aspects of my application for
admission, acceptance, fees or program of studies to the person whose name and address appears
below. I certify that the person named is my selected representative and has my agreement to
access and use this information to assist me to successfully register and access programs at
Seneca College.
I authorize information release to my Agent:
Antonn Brown
C/O Wyndham Kingston Hotel
77 Knutsford Boulevard, Kingston, Jamaica
Mail: P.O. Box 804, Kingston 19, Jamaica
Telephone: 876-754-6125
Email: [email protected] Signature of Applicant:_____________________________________________________
Date: ________________________________________________________________
The Office of Antonn Brown
VALID UNTIL
November 2014
Seneca Agent No: A004242