Liberal Studies Abroad Application Form

 

Full Name: 
Student Number:
Age (required for medical insurance):
 
          M______     F______
Street:
 
 
Phone Number(s):

 
 
City:
Email:
Province/State:

 
Postal Code:
Country:
Passport Number and Country:
Program Location Desired:

 

Year Program Offered: 
Participant Status Desired (check one):

 

       Credit Student 

        Audit Student 

        Companion
 
Registration Status (check one):

Current VIU Student 

    Past VIU Student 

    Applying to Enter* 

    Visiting Student** 
Courses desired:
Do you have third-year standing (completion of 54 credits)?:

 


I acknowledge that, except in the case of cancellation of the program by Vancouver Island University, all deposits and monies remitted by me in respect of this program are non-refundable.

Signature:

Date:
Do you have a medical or other condition which you feel program organizers should know about?  If yes, please specify: 

* Entering Students: Application for Admission Form will be sent to you on receipt of this application; return it with a cheque for the application fee payable to Vancouver Island University, and, if applying as a credit student, arrange for all post-secondary transcripts to be sent to Libby McGrattan in the Liberal Studies Department.

** Visiting Students: Application for Admission Form will be sent to you on receipt of this application; return it with a cheque for the application fee payable to Vancouver Island University, and arrange for a letter of permission from your current institution to be sent to Libby McGrattan in the Liberal Studies Department.

All Applicants: Send this form to Libby McGrattan, Liberal Studies Department, Vancouver Island University, 900 Fifth Street, Nanaimo, BC, V9R 5S5, Canada, with a cheque or money order for $300.  This deposit will be returned if for any reason you are ineligible for Liberal Studies Abroad.