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428-Program Application Form

This document is an advanced standing application form for students wishing to transfer programs or be readmitted to Conestoga College beyond the first semester. It provides instructions for completing the form, including noting a $30 processing fee. The form requests personal details such as name, address, program and semester details, admission requirements, and payment information. It notes that personal information collected will be protected under privacy legislation.

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Diana Tran
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67 views1 page

428-Program Application Form

This document is an advanced standing application form for students wishing to transfer programs or be readmitted to Conestoga College beyond the first semester. It provides instructions for completing the form, including noting a $30 processing fee. The form requests personal details such as name, address, program and semester details, admission requirements, and payment information. It notes that personal information collected will be protected under privacy legislation.

Uploaded by

Diana Tran
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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RO 428 2021/05

Advanced Standing Application Form


Use this form for:
- Program Transfer with Advanced Standing: Currently enrolled in a Program and wish to transfer to a semester beyond semester one of another program
- Readmission with Advanced Standing: Formerly enrolled in a Program and wish to be admitted to a program beyond semester one
Note: If you need help to complete this form, please call the Information Centre at 519-748-5220, ext. 3656.
Processing Fee A $30 fee is charged for processing this information. Form to be submitted to the Registrar's Office. This item is not taxable.

❒ Mr ❒ Mrs ❒ Ms OEN # ___________________________ Student # _________________________


Last Name ____________________________________ First Name _______________________ Second Name _______________________
Previous Last Name _____________________________________________________________ Date of Birth (Y/M/D) __________________
Apt. #, Street # and Name _________________________________________________________ City _____________________________
Province or Country ______________________________ Postal Code _______________________ Tel. No. _
Alternate Tel. No. _______________________________ Email __________________________ Fax No. _
Have you attended a program or course at Conestoga? ❒ Yes ❒ No ❒ Full-time ❒ Part-time
Program Attended ______________________________________________________________ Years Attended ______________________
❒ Canadian Citizen ❒ Permanent Resident (attach documentation) ❒ Student Visa (attach documentation) OR Country of Citizenship _
❒ I have attached proof of the Admission Requirements for the program(s) listed below.
Admission requirements are listed in College publications, or call the Information Centre 519-748-5220, ext. 3656
1. Program Name ______________________________________________________________ Program Number ____________________
Semester or Level _ Campus _______________________ Start Date* ___________ Full-time ❒ Part-time ❒ Co-op ❒ Non Co-op ❒
2. Program Name ______________________________________________________________ Program Number _____________________
Semester or Level ___________ Campus _______________________ Start Date* ___________ Full-time ❒ Part-time ❒ Co-op ❒ Non Co-op ❒
3. Program Name ______________________________________________________________ Program Number ____________________
Semester or Level _ Campus _______________________ Start Date* ___________ Full-time ❒ Part-time ❒ Co-op ❒ Non Co-op ❒
* If the requested start date is not available, applicant may be considered for the next available start date.

METHOD OF PAYMENT Send to:


Total fee payable $ _________ Without payment, this application cannot be processed. Conestoga College, Registrar's Office
❒ Debit Card (in person only) Email: clientservices@conestogac.on.ca
❒ Cheque or ❒ Money Order (payable to Conestoga College, we do not accept post-dated cheques) Fax 519-895-1097
❒ VISA ❒ MasterCard ❒ American Express
Credit Card Information (Credit card will not be billed until registration accepted) Freedom of Information The personal information
Credit Card Expiry Date Month Year collected on this form is used for administrative purposes
of the Registrar's Office under the authority of the
Credit Card Number Ontario Colleges of Applied Arts and Technology Act,
R.S.O. 2002, and regulations thereunder. Personal
Cardholder’s Name First Name Surname information will be protected in accordance with the
Freedom of Information and Protection of Privacy Act
Cardholder’s Signature _____________________________________________ (FIPPA).

I certify that the above information is true and complete. I understand that any false or incomplete information submitted in support of my application may invalidate my
application. I have read the Freedom of Information and Protection of Individuals Privacy statement.

Signature of Applicant _______________________________________ Date _______________


Office Use Only Date___________________________________________________ Charge ________________________________________________________________
Receipt No._________________________________________________________ Clerk Initial _____________________________________________________________

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