GLOBE Canadian Student Form B003

Global Bridge Education Placement Services (GLOBE)

Connecting people through education.
Canadian Student Form

Form: D-043: Christine Dionisio
Disclosure Consent Form

We appreciate your interest in pursuing your education in Canada with the Global Bridge Education Placement Services (GLOBE). We want you to know that we are excited about your decision to pursue the services of GLOBE and value the security of the information you share with us.

Before continuing with the consultation and planning sessions as steps toward your admission to designated learning institutions in the country, we are seeking your full disclosure and consent on the following:

o That you made a free decision without any form of coercion, intimidation, or unfair influence by the Global Bridge Education Placement Services or any of its representatives;

o That you do not hold GLOBE and its representatives liable resulting from your decision to seek our services;

o That you agree and allow GLOBE to collect your information relevant to your school admission;

o That you allow GLOBE to share your personal information with colleges, universities involved in the admission processes.

o That you willingly provide GLOBE personal information to assist you in your student loan application, should you require assistance in the application and submission of your student loan.

Please affix your signature below if you agree with the above statements

CONFORME:
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Canadian Residency Status*
When would you like to start your program?*
Program choice # 1*
Program choice # 2 (optional)
Program choice # 3 (optional)
Do you require assistance applying for Student Loan and Grants?*
Do you have an existing student loan?
Have you already inquired from a different school?
If yes, please state the name of the school?
Please pick a time for our Advisor to reach you so we can complete your registration.*
Do you have any questions or comments you would like us to know?
Signature*

Clear
Date Signed*

MonthDayYear
Date
Thank you for choosing GLOBE.

We will reach out to you within 2 business days.
Should be Empty:

Global Bridge Education Placement Services (GLOBE)

Canadian Student Form

Thank you for choosing GLOBE.