Home | Contact Us | GPC Careers | Sitemap

Student Services

Alumni & Donors

Online Application Form

Application for Admission

Location of Program:

Program Name:

Term:

Full Time

Part Time

Personal Information

First Name: *

Maiden or Previous Name:

Middle Name:

Surname: *

Gender:

Male

Female

Date of Birth

Day:

Month:

Year:

E-mail:

Permanent Address

Home Phone: *

Postal Code: *

Province: *

Street/Box Number: *

Town/City: *

Cell Phone:

Business/Alternate Phone:

Address While Attending Program:

Same as Permanent Address

check box if same as permanent address

Alternate Address

Street/Box Number:

Town/City:

Province:

Postal Code:

Phone Number:

Emergency Contact

Name:

Relationship:

Phone:

The following information is voluntary

Marital Status:

Married

Single

Common-law

Divorced

Widowed

Separated

Number of Dependents:

Citizenship:

Canadian Citizen

Landed Immigrant

Foreign Student

Foreign Worker

Other

Citizenship Other:

if citizenship is 'other'

Non Canadian Citizens

Citizenship:

Citizenship Month:

Citizenship Year:

© 2009 Great Plains College. Privacy