Identity

Legal first name

Emma
Middle name

Legal last name

Brooks
Preferred first name
Em

Gender
FEMALE
Birth date
SEP/07/2001
Personal education number (PEN)
For current or past BC high school students only

12

Citizenship / Language

Country of citizenship*

Canada

Status in Canada*
Canadian Citizen

Country of birth*

Canada

Is English your primary language?*

 Yes
No

Aboriginal Status

Do you identify yourself as an Aboriginal person?

Yes
No
If you identify yourself as an Aboriginal person, are you (please check all that apply)

First Nations
Mtis
Inuit

Please send me information on services available to Aboriginal students

Contact Information
Mailing address*
Street address (e.g. 12 - 123 Main Street)

Line 2 (optional)

Line 3 (optional)

City*

Province / State
For Canada / US only

Country*
 Canada

Postal code / ZIP code*

Personal email address*

em

Home and / or mobile phone number*

Home area code and number

Mobile area code and number

Emergency Contact Information

First name

LISA
Last name

BROOKS

Phone number
Area code and number

Relationship
Mother
Education

Highest level of education completed*

High School Graduation

Location of school*

Low er Mainland / Fraser Valley

Year completed or last year of studies*

20