EAP Student Information Card

Your Information
Name*
First Last
Student Number*
Current Living Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Date of Birth*
MM slash DD slash YYYY
Are you a permanent resident/Canadian citizen?*
- Yes
- No
Study Permit*
- I have a study permit
- My study permit is under review
Study permit expiration day*
MM slash DD slash YYYY
Emergency Contact
Emergency Contact Name*
First Last
Emergency Contact Phone*
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

Brandon University