“以下表格请用英文填写，姓名请按护照拼音填写。”

P L E A S E   P R I N T   C L E A R LY    请清晰打印

1 . Personal Information （学生个人信息）
PREVIOUS YORK STUDENT # (if applicable) 

(曾用约克大学学号)

DATE OF BIRTH(出生日期)

CANADIAN SOCIAL INSURANCE # (if applicable) (加拿大社会保险号，如有)

Gender:(性别)

Optional:(婚姻状况，可选)

LAST NAME/FAMILY NAME(姓)

PREVIOUS LAST NAME (if applicable)(曾用姓)

ALL LEGAL GIVEN NAMES (underline name most commonly used)(名，将常用名划上下划线)

APT. #

STREET ADDRESS(街道地址)

CITY(城市)

PROVINCE/STATE(省/州)

COUNTRY(国家)

POSTAL CODE/ZIP CODE(邮政编码)

HOME TELEPHONE # (incl. area code)(家庭电话-包括区号)

ALTERNATE TELEPHONE # (incl. area code)(其它电话-包括区号)

E-MAIL ADDRESS(电子邮件地址)

COUNTRY OF CITIZENSHIP(国籍所在国家)

FIRST LANGUAGE (specify)(第一语言)

 

2 . Status in Canada:（在加拿大的身份）

Canadian Citizen Currently on, or will require, a Study Permit （已获得或即将申请学习许可）
Other (specify) （其他，请注明）
Permanent Resident of Canada: date of arrival into Canada (D) (M) (Y)
 （加拿大永久居民）

 

3.For Classes Beginning（选择开学期）

January 2012: Liberal Arts & Professional Studies, Glendon, Health, Science & Engineering （2012年1月：文科与专业研究学院，Glendon英法双语学院，健康学院，科学与工程学院。）
May 2012: Liberal Arts & Professional Studies, Glendon, Health, Science & Engineering（2012年5月：文科与专业研究学院，Glendon英法双语学院，健康学院，科学与工程学院。）
September 2012: All Faculties, including Liberal Arts & Professional Studies（2012年9月：所有学院，包括文科与专业研究学院。）

 

4 . Program Selection（选择专业）
You can select a maximum of two degree programs and one certificate OR
you can apply as a Visiting Student. (See back of form for program codes.) （最多可以选择2个学位专业和1个文凭专业或者申请成为访问学生，专业代码请点击此处查看填写。）

1）Code: Faculty: Major:

2 ）Code: Faculty: Major:

 

 

CERTIFICATE
Name of certificate
FOR VISITING STUDENT APPLICANTS ONLY（仅访问学生填写） (please select one of the following):
I am an undergraduate degree-holder from (specify university)：
I am applying with a letter of permission (specify university currently attending)：
    Faculty and program in which you would like to take the majority of courses：
I am applying to fulfill the requirements for a professional Designation：
I am applying to the Bridging Program for Internationally Educated Professionals：

5 . All college/university studies completed or being completed （在读或曾就读过的大学或学院）
 (include York University, if applicable) (start with most recent)

FROM(从) TO(至)
NAME OF SCHOOL(学校名称)
LOCATION (province/state; country)(学校地址，省/州；国家)
PROGRAM/ MAJOR(课程/专业)
SPECIFY DEGREE/DIPLOMA AWARDED (if applicable)(获得学位/文凭，如有)

6 . Pre-university study/bridging courses or university preparation courses （大学预科或桥梁课程或大学预备课程）

Please indicate the name and location of any pre-university course(s) taken:  Month: Year:

7 . Secondary school(s) attended(start with current or most recent) （就读过的中学）

高中部分：
FROM(从) TO(至)
NAME OF SCHOOL(学校名称)
LOCATION (province/state; country)(学校地址，省/州；国家)
LAST GRADE / LEVEL COMPLETED(最高年级/等级)
SPECIFY DEGREE/DIPLOMA AWARDED (if applicable)(获得学位/文凭，如有)

FROM(从) TO(至)
NAME OF SCHOOL(学校名称)
LOCATION (province/state; country)(学校地址，省/州；国家)
LAST GRADE / LEVEL COMPLETED(最高年级/等级)
SPECIFY DEGREE/DIPLOMA AWARDED (if applicable)(获得学位/文凭，如有)

8 . Activities when you were not a student（非应届毕业生，请填此项）
(start with current or most recent and include ESL activities). Applicants should submit an up-to-date resumé if out of academic study for more than one year。

FROM(从) TO(至)
ACTIVITY OR NATURE OF WORK(活动或工作性质)

Protection of Privacy

York University gathers and maintains information for the purposes of admission, registration and other fundamental
activities related to being a member of the University community and to attending a public post-secondary institution in the Province of Ontario. When signing an application for admission, you should know that the information you provide, and any other information placed into your student record, will be protected and used in compliance with Ontario's Freedom of Information and Protection of Privacy Act. The information on this form is collected under the authority of The York University Act, 1965 and is needed for educational, administrative and statistical purposes and to process your application for admission. The information will be used to verify qualifications and decide your eligibility for admission. Upon admission and registra- tion, this information will form part of your student record and will be used to document your progress in an academic program. If you have any questions about the collection, use and disclosure of your personal information by York University, please contact the Manager Information Service, Bennett Centre for Student Services, 99 Ian MacDonald Blvd., York University,
4700 Keele Street, Toronto, Ontario, Canada  M3J 1P3, 416-736-5000. www.yorku.ca/secretariat/infoprivacy


Declaration and Consent of Applicant

I have read and agree to the following:
1. I certify that the information I have provided in this application is true, complete and accurate in all respects, including my declarations as to citizenship and immigration status in Canada, and that all available information requested in this application has been disclosed.
2. All information I have provided in connection with this application is subject to verification and audit by York University.
3. I shall provide supporting documentation to York University to verify my eligibility upon request.
4. I consent to the disclosure by York University of personal information I have given in this application as follows:
a. to referees I have named and to other educational institutions when necessary to verify my statements.
I understand that any misrepresentation on this application or failure to provide my consent to authorize York University to verify my information on this application may result in cancellation of my admission or enrollment status.
b. to family members, friends or representatives named below who may enquire on my behalf about my application

Name（授权人姓名）: Tony Zeng
Relationship to me（授权人与申请人关系）:
Applicant's signature（申请人签名）:
Date（申请日期）:  此栏打印后必须手写签字

（注：以上信息填写完毕后，需打印，再在最后两栏中手写签字，将此书面申请表，连同其它申请材料寄至加拿大约克大学中国项目办公室。）