Student Info

Student Info Sheet

Glaze Gallarde | 825 343 8855 | glazegallarde@yahoo.com
NAME:*

First NameMiddle NameLast Name
ADDRESS:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Best Email Address:*
Phone Number*
Please enter a valid phone number.
Marital Status:*
Date of Birth:*

MonthDayYear
Date
Residence Status in Canada*
Social Insurance Number (If Applicable)
If Applicable
Mode of Study:*
Program You Are Interested:*
Valid ID Upload:*

Please provide FRONT & BACK images.
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Highest Education Credential Upload:

Please provide clear copy/picture if applicable.
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Highest Education Attained*
High School Graduation Date:*
Month & Year
Total 2023 Income (Line 1500)*
Student Applicant's Income 2020/2021
Referred By:
By leaving it blank, you agree that no one referred you.

Dependent Children Information ( If Applicable )

EMERGENCY CONTACT INFORMATION:*

FULL NAME:

COMPLETE ADDRESS:

CONTACT #:RELATIONSHIP TO YOU:

Postal / Zip Code
SPOUSE / COMMON LAW INFORMATION

Last NameFirst Name
Phone Number
Spouse / Common Law Partner
Date of Birth

MonthDayYear
Spouse / Common Law Partner
Social Insurance Number (SIN)
Spouse / Common Law Partner ( If Applicable )
Total 2022 Income ( Line 150)
Spouse / Common Law Total Income
By signing and submitting this student information sheet, I confirm GLAZE GALLARDE as my exclusive marketer for East West College and/or Nova Career College. I authorize them to collect my information and assist with my application process. I certify that all information provided is true and accurate to the best of my knowledge. I accept full responsibility for any false statements or inaccuracies. Additionally, I acknowledge that providing false information may result in my dismissal from the program, for which the marketer is not responsible. I fully understand the guidelines and processes of the school procedures.
Date Signed:*

MonthDayYear
Signature*

Clear
Should be Empty:

Student Info Sheet