Personal Information

Legal Names
FIRST OR GIVEN NAME(S)
Braedan
MIDDLE NAME(S)
Connor Masayuki
LAST OR FAMILY NAME
Kanai
Other Names
PREFERRED FIRST NAME
(N/A)
FORMER LAST OR FAMILY NAME
(N/A)
Other Details
DATE OF BIRTH
(Not Specified)
Language/Citizenship
PRIMARY LANGUAGE SPOKEN AT HOME
English
COUNTRY OF CITIZENSHIP
Canada
VISA STATUS
(Not Specified)
Contact Information
Mailing Address
COUNTRY
(Not Specified)
(Not Specified)
STREET ADDRESS
(Not Specified)
(N/A)
PROVINCE
(Not Specified)
CITY
(Not Specified)
POSTAL CODE
(Not Specified)
Telephone Numbers
PRIMARY PHONE
(Not Specified)
OTHER PHONE
(Not Specified)
Emergency Contact
DO YOU WANT TO PROVIDE AN EMERGENCY CONTACT
Yes
EMERGENCY CONTACT'S FULL NAME
(Not Specified)
EMERGENCY CONTACT'S EMAIL ADDRESS
(Not Specified)
Emergency Contact's Telephone Numbers
PRIMARY PHONE
(Not Specified)
OTHER PHONE
(Not Specified)
Academic History
High Schools
Lord Tweedsmuir Secondary
LOCATION
British Columbia, Canada
DATES ATTENDED
2014-09-02 to 2019-06-30
CURRENT/COMPLETED GRADE
11
High School Student Numbers
PERSONAL EDUCATION NUMBER (PEN)
(Not Specified)
OUAC REFERENCE NUMBER
(N/A)
Post-Secondary Institutions
Application No. 10064394
TERM
Summer 2018
PROGRAM
Health Foundation - Psychiatric Nursing Intended
Program Selection
Term & Admission Category
WHICH TERM DO YOU WISH TO START?
Summer 2018
WHAT CATEGORY BEST DESCRIBES YOU?
Undergraduate (Domestic)
Choose your Faculty
FACULTY
Health
PROGRAM
Health Foundation - Psychiatric Nursing Intended
Program Details
Additional Information
Additional Information
Aboriginal Identity
DO YOU IDENTIFY YOURSELF AS AN ABORIGINAL PERSON OF CANADA?
No
ARE YOU FIRST NATIONS?
(N/A)
ARE YOU MTIS?
(N/A)
ARE YOU INUIT?
(N/A)
Gender
SELECT YOUR GENDER
Male
Applicant Category
PLEASE SELECT THE APPLICANT CATEGORY THAT BEST DESCRIBES YOU.
HIGH SCHOOL: I am/will be a high school graduate before starting my studies at KPU.
Transfer Assessment
WOULD YOU LIKE TO REQUEST TRANSFER CREDIT FOR PREVIOUSLY
COMPLETED POST-SECONDARY COURSEWORK?
No
Educational Goal
TELL US YOUR EDUCATIONAL GOAL AT KPU
I plan to transfer elsewhere
Agent Information and Release for International Applicants
DO YOU HAVE AN EDUCATIONAL REPRESENTATIVE OR AGENT?
No
AGENT NAME
(N/A)
AGENCY
(N/A)
EMAIL ADDRESS
(N/A)
I HEREBY AUTHORIZE KPU TO RELEASE ADMISSIONS, REGISTRATION, AND
TUITION INFORMATION TO THIS ORGANIZATION.
(N/A)
External Funding Sponsorship Information
DO YOU EXPECT TO BE SPONSORED BY AN EXTERNAL FUNDING ORGANIZATION?
No
NAME OF SPONSORING ORGANIZATION
(N/A)
CONTACT PERSON'S NAME
(N/A)
CONTACT'S EMAIL ADDRESS
(N/A)
I HEREBY AUTHORIZE KPU TO RELEASE ADMISSIONS, REGISTRATION, AND
TUITION INFORMATION TO THIS ORGANIZATION.
(N/A)
Support Services
Top of Form
Application Fee
$40.00
KPU accepts VISA, MasterCard, Discover and Visa Debit for payment of the application fee.
Please have your credit card ready, before clicking Submit. You will have five minutes to enter
your payment.
PAYMENT OPTIONS
 I will pay by credit card when submitting my application.

(Not Specified)
Confirm Email Address
Is your current email address, bkanai@shaw.ca?

Yes, this is my current email address.

It's important that we have your current email address, as that's where we'll be sending your
Application Receipt. If you need to update your email address, please do so
at EducationPlannerBC Account - Update Email, before proceeding to Submit & Pay.
Consent for Information Disclosure and Declaration of Applicant
I certify that all statements on this application are true and complete and that no information has
been withheld. I agree that KPU may request and/or confirm any information necessary to
support my application for admission. I understand any misrepresentation may result in the
cancellation of my admission or registration status and that falsifying documents or information
on the application may result in immediate permanent dismissal from Kwantlen Polytechnic
University (KPU). I consent to KPU notifying member institutions of the Association of
Registrars of the Universities and Colleges of Canada if I have been found to have falsified
documents or other information in this application. If I am admitted to KPU, I agree to
familiarize myself with and to abide by the most current policies of the University during my
tenure as a student at the University. I understand that submission of this application in no way
guarantees admission to the university or registration into a course.
Freedom of Information and Protection of Privacy
I consent to the collection, use and disclosure of my personal information as described below
effective on submission of this application.
Privacy Statement
Kwantlen Polytechnic University collects and maintains information for the purposes of
admission, registration, graduation, research, alumni and other purposes consistent with the
fundamental activities and mandate of the university, and with attending a public post-secondary
institution in British Columbia. The information you provide and any other information placed
on the student record will be protected, used and disclosed in compliance with British
Columbias Freedom of Information and Protection of Privacy Act (FIPPA). The information on
this form is collected under the authority of the University Act and is needed to process your
application for admission. The information you provide on this form may be shared with the
Ministries of Education and Advanced Education, or other related government agencies and dual
enrolment partners in a manner compliant with the FIPPA. Any questions concerning the
collection, use, storage or disclosure of this information should be directed to the University
Registrar.
Permission to Release
A Third Party Waiver/Release of Information Form must be submitted in order for KPU to
provide access or release for your personal information to any other person.
Exceptions
The FIPPA provides for a limited number of circumstances where KPU may be required to
disclose personal information without your express consent, which may include public health
and safety concerns, law enforcement matters and other reasons as stated in the FIPPA.

I give my Consent for Information Disclosure and Declaration of Applicant