Application Form for Domestic Students

Student Information

Surname (Family Name) *
Given Name *
English Name (if applicable)
Gender *
FemaleMale
Date of Birth *(mm/dd /yy)
PEN # *
E-mail address *
Cellular Number *
Wechat # (if applicable)
Canadian Status *
Permanent ResidentLanded ImmigrantCanadian
Citizenship
Current Local Address *Street Address
City *
Province *
Country *
Postal Code *

FAMILY INFORMATION

Father *Family Name
*Given Name
Mother *Family Name
*Given Name
Permanent Address Street Address
City *
Province *
Country *
Postal Code *
Home Telephone *
Parent's Cellular Phone *
Parent's E-mail address *
Fathers's Occupation *
Mother's Occupation *

LIVING ARRANGEMENTS WHILE STUDYING AT CITY VANCOUVER ACADEMY

Do you need homestay arrangements to be made by City Vancouver Academy? *
Yes 是No 否
(Students may only reside with parents, guardians, relatives, or in a homestay approved by City Vancouver Academy)

APPOINTMENT CUSTODIAN / GUARDIAN

Please choose one of the following *
I request City Vancouver Academy to appoint a custodian for my child.My child will live with the custodian of the following person who is a Canadian Citizen or landed immigrant and is over the age of 25. I can provide proof of legal custodianship.
Family Name
First Name
Relationship
Address Street Address
City
Province
Canada
Postal Code
E-mail address
Phone (Home)
Phone (Business)

EMERGENCY CONTACT

Who is your emergency contact? *
ParentsAppointed Custodian/GuardianIf neither of the above, listed below
First Name
First Name
Relationship
Street
City
Province
Country
Postal Code
E-mail
Phone (Home)
Phone (Business)

EDUCATION HISTORY

Name and location of most recent schools attended
School *
City, Country *
Date Attended *
Grades(s) Completed *

School
City, Country
Date Attended
Grades(s) Completed

HEALTH INFORMATION

Basic health coverage is available to students through the BC Medical Services Plan (MSP) after three months of landing in Vancouver, Canada. Students should buy private medical insurance for at least the first 6 months while in Vancouver, Canada.
If student is already studying in BC, please provide Care Card number or other medical insurance information
Does the student have any medical condition (including severe allergies) or take any medication? *
YesNo
If YES, please describe
Does the student have a perceived or documented learning disability, physical handicap, social integration difficulty, behavioural concern or history of criminal behaviour? *
YesNo
If YES, please describe
Name of Family Doctor
Phone
City, Country

SURVEY

How did you hear about City Vancouver Academy? *
Friend/RelativeNewspaper/MagazineSchool WebsiteInternet (e.g. Google Search)Agent / Agency / SchoolOther
If it was through a Newspaper, Magazine, or Other, please provide the name

AGENCY/AGENT/SCHOOL (if applicable)

Name of Agent/Agency/School
Contact Person
Address Street Address
City
Province
Country / Postal Code
Business Telephone
E-mail address

Important Information

CHECKLIST *
Completed Application Form$200.00 application fee (non-refundable)Original or certified English translated transcripts for past 2 school yearsClear photocopy of the student's passport, driver's license or BC IDClear photocopy of parent/guardian/custodian ID with photo and addressClear photocopy of custodian declaration form, IMM5646 (if applicable)Clear photocopy of Care Card or other Medical Insurance (valid for 6 months)
DISCLAIMER *
A) This application does not automatically admit the applicant to City Vancouver Academy. Admissions depend upon the number of places available, test, academic transcripts, and validity of legal documents.

B) The applicant certifies that all information provided on this application is true and accurate.

C) Should the applicant be admitted, the student and his/her parents or guardians agree to support the rules and values of the school and Code of Conduct.

D) Payment deadline is generally two weeks prior to the first day of class. Any outstanding account balance after the payment deadline is subject to a late payment charge of $20 per day.

E) By paying the tuition, the student agrees that he or she has and will provide all supporting documents necessary to study in City Vancouver Academy and Canada legally.

REFUND POLICY FOR STUDENTS NEW TO CITY VANCOUVER ACADEMY

City Vancouver Academy (the school authority) must post financial guarantees no less than $100, 000 in accordance with the Bonding Act. As a bonded school, City Vancouver Academy provides peace of mind for parents and students, who are guaranteed that their tuition fees are safe and a full education will be provided to each and every student.
I understand and agree to the above Terms and Conditions
Email
Email
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Application Form – Domestic

Application Form for Domestic Students

General Information

Student Information

FAMILY INFORMATION

LIVING ARRANGEMENTS WHILE STUDYING AT CITY VANCOUVER ACADEMY

APPOINTMENT CUSTODIAN / GUARDIAN

EMERGENCY CONTACT

EDUCATION HISTORY

HEALTH INFORMATION

SURVEY

AGENCY/AGENT/SCHOOL (if applicable)

Important Information

Verification

Application Form for Domestic Students

General Information

Student Information

FAMILY INFORMATION

LIVING ARRANGEMENTS WHILE STUDYING AT CITY VANCOUVER ACADEMY

APPOINTMENT CUSTODIAN / GUARDIAN

EMERGENCY CONTACT

EDUCATION HISTORY

PARENT CONSENT

HEALTH INFORMATION

SURVEY

AGENCY/AGENT/SCHOOL (if applicable)

Important Information

Verification