International Education Loyalty Scholarship Application

Please Complete Along With Application on Reverse

To support international students who choose to enroll in a second program, Centennial College is offering a
$1,500 CAD Loyalty Scholarship in Summer 2020, Fall 2020, or Winter 2021 semesters. Based on academic merit,
the recipient can earn an additional $1,500 scholarship for their second semester at Centennial College.

Scholarship Eligibility Requirements

· International students who have fulfilled the academic requirements to complete one post-secondary or post-graduate
program at Centennial College.
· Acceptance into a second program at Centennial College in Summer 2020, Fall 2020, or Winter 2021.

301163421
Student Number: _________________________________

Marketing Management
Name of the program you have completed: _________________________________________________________

Pontes Veronica Silva

Name _______________________________________________________________________________________________________
Last Name (Family Name, Surname) First Name (Given Name) Second Name
08/05/1991
Date of Birth ___________________________________________________ ✔ Female
o o Male
Month Day Year

Brazil
Country of Citizenship ________________________________ Brazil
Country of Residence ____________________________________

Are you applying from within Canada? o Yes, I am in Canada now ✔ No, I am applying from outside Canada
o

____________________________________________________________________________________________________________

Basis for Admission Consideration o Secondary School Graduate or Equivalent ✔ College/University Studies
o
(Attach Original and Notarized Transcripts in English)

Language Proficiency
(Check the test you have taken and provide your score) o TOEFL Score ____________________
o IELTS Score ____________________
o MELAB Score ____________________

Program Choices
(Please list in order of preference)

Program Name Program Number Start Date (Year/Month)

Project Management 2328 2021/09

1. ________________________________________________________________________________________________________

2. ________________________________________________________________________________________________________

3. ________________________________________________________________________________________________________

___________________________________________________________________________________________

Please scan the completed application form along with the application documents required for your program
and email to international@centennialcollege.ca.

Once your application form is received at the college, an acknowledgment will be issued to you with further information about the admissions process.
 centennialcollege.ca/international-apply

Have you attended school or college in Canada before? o

✔ Yes o No
(If yes, please give names of schools, addresses and programs)

School Name and Address Program Name Date Attended

ILAC Pathway
________________________________________________________________________________________________________
2019/09

________________________________________________________________________________________________________

________________________________________________________________________________________________________

__________________________________________________________________________________________

Residence address

Romualdo Gouveia de Castro Street, 206

Street Number and Name ___________________________________________________ Apartment Number _____________________

Osasco SP Brazil
City ____________________________________ Province / State ______ Country ________________ Postal/Zip Code ______________
06075-020

+55 11 98268-5795
Phone ________________________________________________ Fax ________________________________________________
Country Code Area Code Phone Number Country Code Area Code Fax Number

flauor@hotmail.com
E-mail ________________________________________________

First Language English French ✔ Portuguese

Other (Please specify)_______________________________________

____________________________________________________________________________________________________________

Mailing address
(If different from residence address above)

Street Number and Name ___________________________________________________ Apartment Number _____________________

City ____________________________________ Province / State ______ Country ________________ Postal/Zip Code _____________

I certify that the information in this form is true and complete. I understand that any false or incomplete information submitted in support of my
application may invalidate my application. I have further read and understood the Freedom of Information and Protection of Individual Privacy
Statement below.

________________________________________________________________ 09/09/2021
_________________________________________
Applicant Signature Date
_____________________________________________________________________________________________________________
Freedom of Information and Protection of Individual Privacy Act. The information on this form is collected under the legal authority of the
ministry of colleges and universities act. r.s.o. 1980, Chapter 272, S.S.; R.R.O. 1980, Regulation 640. The information is used for administration
and statistical purposes of Centennial College and/or the Ministries and Agencies of the Government of Ontario and the Government of Canada.
For further information, please contact International Education, Centennial College, P.O.Box 631, Station A, Toronto, Ontario, Canada M1K 5E9

Please complete both sides of this form