PRE-REGISTRATION FORM- AG808

Student Information Sheet
Please choose the option that best applies to you and answer honestly.
Are you the main applicant?

Other
Are you completing this form to the best of your ability and fully understanding its contents?
Authorization for the release of student information.
Name of Student

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Citizenship Status
Marital Status:
Is your spouse live? (For Married/ Common Law)
Emergency Contact Name

First NameLast Name
Phone Number
Parent/Guardian Name (Please fill this out if you are 18 years old and below.)

Full Name of your guardianRelationship? (Parents, Guardian, etc.)
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Educational Background:
Where did you finish high school?
(Please put the city, province,country)
High School Name(if applicable)
Highschool graduation date?
Month and Year
Programs you are interested?
Program you are interested, if not listed above.
Month you would like to start?

Time you are available to accept the call?

Rows	9:00 am to 11:00am	11:00 am to 1:00pm	1:00pm to 3:00pm	3:00pm to 5:00pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday (by APPOINTMENT ONLY)

Would you like assistance with any of the following? You can select as many as you need, and it's completely FREE.
Is there any information or specific notes that you'd like to share before our pre- assessment? Please type it below.
Additional Information:
Consent and Authorization:

By signing below, I grant VB Education Consulting permission to use the information I have provided for educational and administrative purposes. I also authorize them to assist me with a pre-assessment for their affiliated schools. I certify that, to the best of my knowledge, the information provided is accurate and complete.
This consent is only valid until
Student Signature
Parent/Guardian Signature (if student is a minor)
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Where did you hear about us?
One VALID GOVERNMENT PHOTO ID (FRONT)

Cancelof
One VALID GOVERNMENT PHOTO ID (BACK)

Cancelof
APPLICANTS HOLDING THEIR PHOTO ID (SELFIE)

Cancelof
TRANSCRIPT OF RECORDS/ DIPLOMA/ ENGLISH PROFICIENCY

Cancelof
Should be Empty:

Student Information Sheet