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8671 Odlin Crescent, Richmond

British Columbia, Canada V6X 1G1
www.rihsc.com

Telephone: 604-244-0100
Facsimile: 604-244-0102
E-mail:
study@rihsc.com

APPLICATION FOR ADMISSION
Please include with this application:
Ø 1 passport size photo
Ø Original transcripts or certified copies
showing secondary or
high school graduation and
any post secondary records
Ø $200.00 non-refundable
application fee

For Office Use
PASSPORT NUMBER
PASSPORT EXPIRY DATE

A. STUDENT INFORMATION
Family Name ___________________
First Name ____________________
Date of Birth _________________________
Year
Month
Day
Male o Female o
Place of Birth ___________________
Citizenship ____________________
Visa Student Yes o
No o
You will begin studies
September o December o April o
Year _______
Last school attended _____________________________________________________
B. HOME ADDRESS & FAMILY INFORMATION
Home Address
_____________________________________________________________________________
Town/City _____________________________

Province/State _____________________

Country _______________________________

Postal Code _______________________

Telephone Number ___________________

Fax Number _______________________

E-mail _______________________________________________________
C. ACADEMIC INFORMATION
Name of present school
____________________________________________________________________________
School Address
____________________________________________________________________________
Telephone Number _______________ Fax Number ___________________
Number of years at this school _________
Names and addresses of last two schools attended

a)______________________________________________________________ Grade_____
b)______________________________________________________________ Grade_____
D. MEDICAL INFORMATION
Do you have medical insurance for studying in Canada?
Yes o No o
Are you on any kind of medication?
Yes o No o
If yes, give full details ________________________________________________________
Have you ever been treated for a nervous condition?
Yes o No o
If yes, give full details ________________________________________________________
Do you have a medical condition or disability that the college should know about?
Yes o No o
If yes, give full details ________________________________________________________
E. PROGRAM APPLYING FOR
English Language Training
Diploma in Computer Science
Diploma in Hospitality and Tourism
Diploma in Business Administration
Royal Roads University Bachelor of Commerce Transfer
Acadia University Bachelor of Computer Science Transfer
F. GOALS
Do you want to obtain employment after graduation?
Do you want to continue studies at a university?

o
o
o
o
o
o
Yes o
Yes o

No o
No o

If yes, where? ________________________________________________________
G. EMERGENCY CONTACT ADDRESS
Name, address and phone number of your parents:
Name _______________________________________________________________
Address _____________________________________________________________
Telephone Number (Home) __________________ (Business) _________________
E-mail ________________________________________________________________
Name, address and phone number of where you will be staying in Richmond or Vancouver:
Name _________________________________________________________________
Address _______________________________________________________________
Telephone Number (Home) ______________________
E-mail __________________________________________________________________
H. HOW DID YOU HEAR ABOUT RICHMOND INTERNATIONAL COLLEGE?
o
o
o
o

Friend/Relative
o Newspaper ______________
Website ____________________
o Telephone Directory _______
Educational Fair in ____________
Educational Agents (Please provide the name below.)
______________________________________________________________

I. DECLARATION
I declare that all information on this application is true and complete. I consent to the disclosure of
information on this form to other educational institutions when necessary to verify my
qualifications. I understand failure to provide my consent, or any misrepresentation, may result in
cancellation of my admission or registration status.
__________________________________
Signature

___________________________
Date of Application