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Student Questionnaire Form
Student Questionnaire Form
Please complete this questionnaire using the space provided. Read the questions
carefully and answer all applicable questions.
1) Please disclose the name of the agent or representative who assisted you with
your admission forms and/or study permit application.
NOTE: Failure to disclose an agent or representative could negatively effect the
decision on your study permit application.
Agent or representative’s
name:________________________________________________________________
Business
address:______________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Phone: _______________________________________________________________
E-mail: _______________________________________________________________
2) Provide the details of your education/work experience since the age of 18.
Start with the most recent information. Under “Activity” write your course of
study or details of job if you were working. If you were not working or studying,
provide information on what you were doing. For example: unemployed,
travelling, etc. DO NOT leave any gaps.
1
3) Complete the following chart with regard to a) your parents and b) any other
individual, including yourself, who is a primary financial support for your
program of studies, where applicable.
MOTHER
Name:
Other (1):
Name:
Relationship to
Applicant:
Other (2):
Name:
Relationship to
Applicant: