Centennial College Application Form

Student Number

Student Name VKAEG BU OKECHUKWV ONWBIKO

First Name (Given Name) Second Name
Last Name (Family Name, Surname)
Date of Birth 22 Female VMale
Month Day Year

Country of Residence
Country of Citizenship,

Information Release
(Thissection is required if the student agrees to add an agent in his/her profile.)
Pursuant to the Freedom of information and Protection of Individual PrivacyAct, Ihereby authorize Centennial College torelease anyand all
information related to any andall aspects of myapplicationfor admision, acceptance, fees or programof studies to the personwhose name
and address appears below. lcertify that the person named is my selected representative and has my agreement to access and use this
information to assist me to successfully register and access programs at Centennial College.
Iauthorize information release to my representative

Agent Name ApplyBoard Inc.

Agent Number

Agent E-mail applications@applyboard.com

Agent Phone Number 519 9006001
Agent Address Suite 600, 101 Frederick St. - Kitchener - Ontario - N2H 6R3

26 Decmber 2023
Date
Student Signature

Freedom of Information and Protection of Individual Privacy Act. The information on this form is collected under the legal authority of the
administration
ministryof colleges anduniversities act. r.5.0. 1980, Chapter 272, S.S.;R.R.0.1980, Regulation 640. The information isusedfor
andstatistical purposes of Centennial College and/or the Ministries and Agencies of the Government of Ontario and the Government of Canada.
Forfurtherinformation, please contactInternational Education, Centennial College, P.0.Box631,Station A, Toronto, Ontario, Canada M1K5E9