Carleton Fast Track- Application Form

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Family Name(s):*

Given Name(s):*

Age:*

Date of Birth:*

Gender:*
Male
Female

Citizenship:*

First Language:*

Status in Canada:*
Student Authorization (Study Permit)
Canadian Citizen/Permanent Resident

Street Address:*

City and Province:*

Country:*

Postal/Zip Code:*

Phone Number*

Personal Email Address:*

Agency Name:

Agent Name:

Agent Email:

Agent Phone Number:

Language Test Scores:*
*Must submit copy of test results

IELTS, Overall 6.0 required (Minimum score of 6.0, no section less than 5.5)

TOEFL, Overall 65 required (Minimum score of 65, no section less than 12)

Choose your University Program:
(Choose one to three programs from the list below)
*Co-op available
+Additional concentrations available

First Choice: *

Second Choice:

Third Choice:

Highest level of education completed (high school, college, university) :

Name of High School:*

City:*

Country:*

From:* (month/year)

To:* (month/year)

Graduation certificate awarded:*
Yes
No

Name of College/University “If Applicable”

City:

Country:

From: (month/year)

To: (month/year)

Diploma/Degree Awarded:
Yes
No

Authorization:*
I certify that all of the aforementioned information is accurate and true to the best of my knowledge.

Student Signature:*

Date:*