OFFICE USE ONLY

HOLLAND COLLEGE APPLICATION FORM

Applications must be submitted with a $40 application fee in order to be processed. The International Student application fee is $100. The Police
Science program has a separate application kit and a $125 application fee. Please visit our website for details, or contact the Admissions Office.
The Holland College Application Form can also be completed online. hollandcollege.com!apply

PERSONAL INFORMATION (PLEASE P RINT)

D MR D MS D MRS D MISS
PREVIOUS NAME (if applicable)

LAST NAME FIRST NAME MIDDLE INITIAL(S)

ADDRESS

CITY PROVINCE POSTAL CODE

HOME PHONE CELL PHONE EMAi L (We will be corresponding with you via email. Please ensure this address is secure and accessible.)

DATE OF BIRTH (YY I MM I DD) S OCIAL INSURANCE NUMBER (Required for all Canadian residents.)

EMERGENCY CONTACT NAME PHONE NUMBER

CITIZENSHIP STATUS

D Canadian Citizen D Permanent Resident (Landed Immigrant) D Refugee with protected person status D Other

COUNTRY OF CITIZENSHIP (if not Canadian)

If you are an Aboriginal person, that is, First Nation (North American Indian), Metis, or Inuk (Inuit), check here: D
Note: First Nations (North American Indian) include Status and Non-Status Indians.

PREVIOUS EDUCATION

Please include all educational history, even if the program was not completed.
HIGH SCHOOL, TECHNICAL I VOCATIONAL SCHOOL OR GED:

NAME OF SCHOOL LOCATION (CITY/PROVINCE) HIGHEST GRADE COMPLETED DATE COMPLETED

Have you taken or are you enrolled in an Adult Education program? DYES ONO

IF YES, PROGRAM NAME

PREVIOUS COMMUNITY COLLEGE, UNIVERSITY AND/OR OTHER EDUCATION:

NAME OF SCHOOL LOCATION (CITY/PROVINCE) HIGHEST LEVEL COMPLETED DATE COMPLETED

NAME OF SCHOOL LOCATION (CITY/PROVINCE) HIGHEST LEVEL COMPLETED DATE COMPLETED

PROGRAM INFORMATION

NAME OF PROGRAM LOCATION START DATE

You are applying as a D full-time D part-time student