SELKIRK COLLEGE APPLICATION

FOR ADMISSION & RE-ADMISSION

APPLY AND PAY ON-LINE AT APPLY.EDUCATIONPLANNERBC.CA/APPLY/COMPLETE-APPLICATION/SELKIRK
OR FILL OUT THIS APPLICATION FORM. PLEASE FILL OUT ALL SECTIONS.

SELKIRK COLLEGE STUDENT ID HAVE YOU PREVIOUSLY ATTENDED SELKIRK COLLEGE? Yes No

PERSONAL DATA

Legal First Name: Legal Last Name:

Legal Middle Name: Previous Last Name(s)

PEN Number: Gender: Male Female Date of Birth (yy/mm/dd):

(if known)

PERMANENT MAILING ADDRESS

Number: Street: PO Box:

City: Province/Country: Postal Code:

Day Phone: Evening Phone: Cell Phone:

Email(s):

CURRENT MAILING ADDRESS (IF DIFFERENT FROM PERMANENT)

Number: Street: PO Box:

City: Province/Country: Postal Code:

Day Phone: Evening Phone: Cell Phone:

NEXT OF KIN - EMERGENCY CONTACT

Full Name:

Email(s): Phone:

CITIZENSHIP INFORMATION

Canadian Citizen: Yes No - If No, what citizenship:

Landed Immigrant: No Yes - If Yes, date of landing: Document of landed status must be submitted.

Acceptable documentation can be found at: http://www.cic.gc.ca/english/information/applications/guides/5545ETOC.asp#5545E2

VOLUNTARY DISCLOSURE Selkirk College is dedicated to providing access to Indigenous students and supporting them in their efforts to achieve their goals.

Do you identify yourself as an Indigenous person, that is Métis, First Nations or Inuit? Yes No

If Yes, please check all that apply: Métis First Nations ____ Status ____ Non-Status ____ Treaty ____ Non-Treaty Inuit

Do you require special arrangements or assistance for a documented disability? Yes No

(For example: learning disability, physical disability, mental health,
required service dog etc?) Accessibility Services will contact you to offer support.

Optional: Are you or were you a Youth in Care in British Columbia? Yes No Not certain I qualify

Within Reach. Beyond Imagination. 1 888 953 1133 selkirk.ca

 PROGRAM CHOICES

Before completing this section, refer to selkirk.ca/programs for information on programs available. If you are unclear of which program to apply for, contact the
Admissions Office at 250.365.7292. You may wish to discuss your educational goals with a College Counsellor.

Student Status: New Student (first application) Continuing Student (same program) Returning Student (different program)

Name of Program: Year: First Year Second Year Third Year

Associate Degree: Arts Science Distance Education: Apprenticeship Level: 1 2 3 4 TWID# :

Academic Upgrading: Castlegar Nelson Trail Grand Forks Kaslo Nakusp

Grades 9-12 Grades 9-12 Grades 9-12 Grades 9-12 Grades 9-12 Grades 9-12

Adult Special Education: Castlegar Nelson Trail Grand Forks Kaslo Nakusp

Start Date (mm/yy): Full-Time Part-Time

PREVIOUS EDUCATION

HIGH SCHOOL EDUCATION

Name of High School Attended (most recent):

City: Province/Country: School District Number:

Highest Grade Completed: Years Attended (from/to): Graduation Date (mm/yy):

POST-SECONDARY EDUCATION
NAME OF COLLEGE / UNIVERSITIES CITY / PROVINCE YEARS ATTENDED (FROM/TO)

1.

2.

3.

FEES & PAYMENT

An application fee is required if you are a New Student (1st Application) or a Returning Student (to different program).
An application fee is not required if you are a Continuing Student (to same program) or Academic Upgrading/Adult Special Education student.
Domestic & International non-refundable application fee amounts are posted at: selkirk.ca / Financial Info / Miscellaneous Fees

By Mail: Attach a cheque or money order and mail to Selkirk College

By Phone: Call in to cashier for credit card payment 1-888-953-1133 ext 21297 or ext 13244
In Person: Cash, cheque, debit, credit card

International Students: complete payment form provided by Selkirk International Department - Email: [email protected]

FREEDOM OF INFORMATION &

PROTECTION OF PRIVACY

DECLARATION: I declare that the information contained in this application is to the best of my knowledge, complete and correct. I hereby agree to comply with the rules and
regulations as listed in the Selkirk College calendar and as amended by the Selkirk College Board. I also agree to any penalty assessed for non-compliance with the rules and
regulations. In signing this application for admission, I understand that Selkirk College will use and maintain the information for the purposes of admission, registration,
student support services, research, alumni and development, administration of the Student Union Health and Dental plan, and other purposes consistent with the mandate
of the institution under the College and Institute Act. Information on admission, registration and academic achievement may also be disclosed to and used for statistical
and research purposes by the College, other post-secondary educational institutions, the Industry Training Authority and the provincial government. Personal information
provided for admission and registration and any other information placed into the student record will be collected, protected, used, disclosed and retained in compliance
with British Columbia’s Freedom of Information and Protection of Privacy Act (R.S.B.C. 1996, c. 165).

APPLICANT SIGNATURE DATE SIGNED

Within Reach. Beyond Imagination. 1 888 953 1133 selkirk.ca