Name Agent Name Agent Phone Number Student Name * Date of Birth * Address * Email * Other Email Mobile Number * Landline Number Emergency Contact Number Landline Emergency Contact Number Do you have Student Permit / Visa * Select Yes No Issue date Expiry date Are you currently attending an institution in Canada Grade 10 Year Started MM/YYYY Year Completed MM/YYYY Percentage Marks in Math/English Name of Board/Awarding Body Grade 12 Year Started MM/YYYY Year Completed MM/YYYY Percentage Marks in Math/ English Name of Board/Awarding Body Degree (Bachelor) / Diploma Completion Year Percentage How many ATKT / Back Logs? Major Subjects / Courses Name of the University / Awarding Body Degree (MS) / PG Diploma Completion Year Percentage How many Backlogs? Major Subjects Name of the University / Awarding Body IELTS Details Listening Reading Speaking Writing Overall Score Test Date Program / Area of Study 1. Intended Program Choice 2. Intended Program Choice Tuition Fees Budget (Range from 12000 – 30000 $ CAD) Experience (If available) Preferred City in Canada / Relatives Details (if any) City State / Province College / University Preference Intake Course with fee in CAD Application Dispatched Date Documents Checklist Please provide the following documents in electronic (scanned) format. The documents must be clearly scanned and legible:
