International Student Application Formfor Admission to Lambton CollegePlease submit form using one of the following methods:

Mail: International Education, Lambton College Fax: 001-519-541-24181457 London Road, Phone: 001-519-541-2438Sarnia, Ontario, Canada E-mail: international@lambtoncollege.caN7S 6K4

Lambton College recommends that students pay fees directly to our college and not through an agent.

Family Name (Last Name):

1. Personal Information

First & Middle Name:

Sex: Male FemaleDate Of Birth: MonthYear: Day:

Address:

City/Town: Province/State:

Postal Code/ZIP: Country:

Country of Citizenship E-mail Address:

Telephone Number: Fax Number

2. Languages

Other Languages:

First Language:

Test Score:

If you have written the TOEFL, IELTS, CAEL, or TOEIC test within the last two years, please complete the following:

Test Date: Was the test computer Based? Yes NoWas the test paper Based? Yes No

Original TOEFL, CAEL, IELTS Test scores are required.

4. Education

Secondary, High School, Middle School

Please check complete levels of education:

College University

Other:

Institution Name:

Last Year Of Attendance: Country

Level Achieved

Institution Name:

Last Year Of Attendance: Country

Level Achieved

Institution Name:

Last Year Of Attendance: Country

Level Achieved

Yes NoI am a current student: We require all official transcripts, documentation and copied (must be officiallytranslated into English), notarized and sent with the application form.

3. Program and Campus Choice

Priority Program Title Program Length Sept./May/Jan Year Campus Location

1

2

3

Start Date

Yes NoHave you been rejected for a Canadian Study Permit before?

All students applying for post-secondary programs must submit all official transcripts and language proficiency test scores with theirapplication. Documents must be officially translated into English and notarized.

6. Requested Enclosures with this Application

Language Proficiency Test Scores

Official transcripts translated into English and notarized

Proof of High School Graduation if under 19 years of age

5. Accommodation

I am interested in the following:

Not Required

College Residence Homestay (English Speaking HostFamily)

Apartment

Undecided

7. Notice of Disclosure- Confidentiality and Use of Personal Data

Lambton College gathers, generates and stores information concerning its international students. This collection is compliant withthe Freedom of Information and Protection of Privacy Act of the Province of Ontario. Lambton College is committed to theprotection of privacy and confidentiality of all its students. The purpose of this data collection is directly related to and needed byLambton College to administer the college/student relationship including the proper recording of student academic progress and toadhere to governmental reporting requirements.

Data collected on this form will be disclosed and used as follows:

l registrarial, administrative and academic offices for record-keeping, institutional analysis, provision of services to students,academic integrity enforcement;l academic counselling and advising offices for advising services;l where the operational necessity of the College requires the disclosure;l federal and provincial government offices and Ministries for funding, statistical analysis and planning purposes;l student associations and societies for services to students;l Student Services offices for the administration of activities including co-op programs, counselling services and residenceadministration;l Registrar's Office for production of graduation lists and convocation programme; Alumni Association for services to alumni;l financial aid, scholarship and award determination;l Student Health Services for health services; Guardme Insurance for insurance purposes; Bluewater Health Unit for health services;l external collection agencies in the event of fee payment default;l athletics and recreational services for sports and athletic services;l Citizenship and Immigration Canada, Canadian Consular Offices, Canada Border Services Agency and CSIS for student/study visaadministration;l Satellite campus partners if the student is transferring;l As required by statue or law.

If you have any questions about the collection, use, and disclosure of this information please contact the International Office atinternational@lambtoncollege.ca

I agree to the terms outlined in this Application Form.

Signed By Date

I declare that the information disclosed on this Application Form is accurate and true.

Signed By Date