First
Name: *
Middle
Name:
Last
Name or Family Name: *
Address
Apt#
or House#: *
Street
Name: *
City:
*
Province/State:
*
Country:
*
Select
Afghanistan
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Algeria
American Samoa
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Bahamas, The
Bahrain
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Republic
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Islands
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Rep
Congo, Republic of
the
Cook Islands
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Gambia, The
Georgia
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Marshall Islands
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Islands
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/ Grenadines
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Islands
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Postal
Code / Zip Code:
Phone
Number: *
Alternate
Phone Number:
E-Mail
Address: *
Date
of Birth:
YYYY
Select
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
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1965
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1963
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1918
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1914
1913
1912
1911
1910
1909
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1907
1906
1905
MM
Select
January
February
March
April
May
June
July
August
September
October
November
December
DD
Select
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Are
you a Permanent Resident (PR) / Citizen or Protected Person
(Refugee) in Canada?
NO
YES
Passport
No.:
Gender:
Select
Male
Female
Marital
Status:
Select
Married
Single
Divorced
Education:
(List
the highest first)
Employment
History:
English
Proficiency:
Select
Excellent
Good
Fair
Average
Poor
Program
you are interested in:
---------------Diploma----------------
Business Management
Industrial Pharmacy
Early Child Care Assistant
Software Engineering
Personal Support Worker
Dental Office and Chairside Assistant
Dental Assistant (Intra-Oral)
Dental Hygiene
Hotel and Restaurant Management
Bioinformatics
Live in Care Giver
--------------------Certificate
-----------------
Office Management
Healthcare
Information Technology
Accounting
ESL
Others
For
Certificate Programs please check Course
Schedules and type in the exact
Program Code.
Study
Year Code:
06
07
08
09
10
eg : For 2006 - 06, For 2007
- 07
Session
(Month Code) : (Note: Check Course
Schedules
for session availability )
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
Select only JAN,APR,JUL or OCT
Session for Diploma Programs.
Second
preference for the Program you are interested in:
---------------Diploma----------------
Business Management
Industrial Pharmacy
Early Child Care Assistant
Software Engineering
Personal Support Worker
Dental Office and Chairside Assistant
Dental Assistant (Intra-Oral)
Dental Hygiene
Hotel and Restaurant Management
Bioinformatics
Live in Care Giver
Preferences
For Batch:
Any
Morning
Afternoon
Evening
Have
you arranged the funds for the program study expenses?
Yes
No
Will
you be seeking financial assistance?
Yes
No
How
did you hear about us?
News Paper
Seminar
Radio
Search Engine
Television
Referral
Notice Board
Flyer
Have
you ever applied to Huron College before? If
yes, then mention the Student ID, otherwise
type NO.*
Extra
Curricular Activities:
Payment
Method & Terms:
Please Select
One:
Bank Draft/Money Order/Certified Cheque
Wire Transfer
Please
Select One:
I will pay for my entire term fee on or before registration
I will provide a letter from an authorized person or
...... agency confirming that
they will pay my entire term fee.
I would like to discuss payment or financing options
...... available
What
is the best way or time to contact you?
Select
E-Mail
Phone
Preferred time :
Name
of Guardian/Parent (if applicable):
Contact
Information:
Agent Code: (Students applying direct
should type DIRECT ) *