CLEAR FORM
Personal Information
Agent Information
Family Name
(exactly as it appears on your passport)
Agent Name
Agent Office
First Name
(exactly as it appears on your passport)
Address Line 1
Gender
Male
Female
Address Line 2
Date of Birth
Month
Day
Year
City
Province/State
Nationality/Native Language
Country
Postal Code
Current Mailing Address and Contact Information:
Telephone
Address Line 1
Email
Fax
Address Line 2
City
Province/State
Additional Information
Country
Postal Code
Have you taken a recognized English Proficiency Exam?
Telephone
Fax
TOEFL
My test score is:
Email
IELTS
My test score is:
You MUST provide us with a fax number or valid email address.
Other
Please Specify:
Home Country Address and Contact Information:
Yes
No
My test score is:
Please include a copy of your test result(s).
Address Line 1
Have you previously been accepted to UNBC ELS?
Yes
No
Address Line 2
City
Province/State
Country
Postal Code
Telephone
If yes, when?
Year
Semester
UNBC Student ID Number
Fax
Email
Program Selection
Please indicate which semester you would like to begin your studies: Semester
Year
How many semesters do you plan on studying for?
I will be applying to pursue an undergraduate degree at UNBC.
Yes
No
I will be applying to pursue a graduate degree at UNBC.
Yes
No
If yes, what is your intended field of study for your degree?
Please note: UNBC does not offer conditional acceptance for Graduate Programs at this time. Please contact [email protected] for more information.
Accommodation
Do you require accommodation?
No
I will find my own accommodation.
Yes
I am applying to UNBC's Residence and Housing Program.
Please apply to UNBC Housing online at: http://www.unbc.ca/housing/apply.html or contact [email protected] for more details.
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Payment Information
The University of Northern British Columbia accepts payment by cheque, bank wire transfer, international money order or credit card (Visa, MasterCard or American Express).
Cheques are to be made payable to UNBC Continuing Studies ELS Program.
All fees are payable in Canadian Funds.
All ELS applications MUST be accompanied by the
non-refundable application and deposit fees:
I have enclosed a cheque.
$650.00
Non-refundable application fees
Visa
I have enclosed a bank draft/money order
Non-refundable application fee ($150.00) and nonrefundable program fee deposit ($500.00)
I have enclosed a wire transfer receipt
MasterCard
American Express
Cardholder's Name
Expiry
Month
Year
Please charge my credit card
Total non-refundable fees enclosed:
$650.00
Card Number
Application Submission
Please send your completed application form with the non-refundable fees to:
English Language Studies
University of Northern British Columbia
3333 University Way
Prince George, British Columbia
Canada V2N 4Z9
Application Checklist
Completed ELS Application Form
Non-refundable application fee ($150.00 CDN) and non-refundable
deposit ($500.00 CDN)
UNBC Undergraduate Application Form (if wanting conditional admittance to
UNBC)
Copies of official transcripts in English translation from all high
school and post-secondary schools attended
or Fax: 1-250-960-5120 with your payment information
Transfer Policy
Undergraduate Application fee ($76.50 CDN) and Document
Evaluation fee ($40.80 CDN)
Students wishing to transfer or defer their start date to a future semester must do
so in writing before the program starts. A $75.00 CAD non-refundable transfer
fee applies. Once this fee has been paid, and an Application Transfer Form has
been submitted, the ELS program will issue a new acceptance letter to the
student.
Copy of your Passport photo page
Copies of the results from any English Language tests that you have taken
Conditions and Requirements
I meet the minimum age requirement (18 on the first day of the program)
I meet the Canadian Visa requirements and will obtain the necessary visa.
I will provide adequate Medical Insurance for the duration of the program.
I have some basic knowledge of the English language.
I have read, understand and agree to the program guidelines.
I understand the refund and transfer regulations as outline.
Program Guidelines
I must attend and participate in classes, lectures, seminars, workshops and
socio-cultural activities.
I must be punctual and speak English at all times.
I understand that a responsible standard of behaviour and respect is expected
of all students for rules and regulations set by the University of Northern
British Columbia.
I hereby apply for admission to the English Language Studies Program at the University of Northern British Columbia. If admitted, I will pay all charges as outlined in the application
form and agree to abide by the rules and regulations as outlined in the program guideline. I understand that in submitting this application I am not guaranteed admission or
residency. I further understand that the application will not be accepted or processed without the following non-refundable fees: $500.00 deposit for each program, $150.00
application fee . The balance of my program fees is due no later than five (5) weeks before my program begins. If full payment is not received, my seat will not be guaranteed or my
registration may be cancelled. The University of Northern British Columbia reserves the right to cancel or reschedule courses without notice if enrollment is insufficient. If a course is
cancelled or rescheduled, the liability of UNBC is limited to a refund of my course fees, or if I desire, transfer to another offering. The relevant law for all matters concerning this
program shall be the law of the Province of British Columbia, Canada. The information I have provided will be used for the purpose of admission, registration, and other decisions
relating to the English Language Studies program. By signing below I authorize my agent to collect information on my behalf if an agent has submitted.
Signature of Applicant
Date
Please Print Name
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Revised May 7, 2015