LPCMC Student Application Form

PrefixFirst NameLast Name

MaleFemalePrefer not to say

Street Address

Street Address Line 2

Postal / Zip Code

Street Address

Street Address Line 2

Street Address

Street Address Line 2

Same as aboveAdd a different mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Country CodePhone Number

IELTSTOEFLPearson PTEOthers (please specify)

October/November 2021

I certify that the information given in the application is correct and complete. If I am admitted to the LPCMC, I undertake to observe the LPCMC's regulations and to ensure payment of fees and other financial liabilities to the LPCMC.I agree that the LPCMC may process personal data contained in the form, or other data which the LPCMC may obtain from me or other people whilst I am an applicant and student, for any purposes connected with my application and for any other legitimate reason.Disclaimer: The LPCMC undertakes to make every reasonable effort to provide the teaching and facilities necessary for your programme of study. However the LPCMC reserves the right, if such action is considered to be necessary, to vary the content or delivery method of any course at any time. In addition, the LPCMC may, at its sole discretion, discontinue or amalgamate any course(s). In these rare cases the LPCMC will notify you as soon as possible, and reasonable steps will be taken to provide a suitable alternative to a discontinued course

I, the parent/guardian of the applicant hereby consent to this application for study

Student Application Form

Permanent Contact Details

Academic Qualifications

Professional Qualifications

Work Experience

English Proficiency

Course Selection

Supporting Documents

Declaration