Application Form - Polytechnic Institute of Northern Canada

APPLICATION FORM FOR Prospective Students

APPLICANT INFORMATION

First Name

Last Name

Street Address

Apartment/Unit

City

Territory

Province/State:

Postal Code

Contact Number

E-Mail Address

Date of Birth (Optional)

Preferred Pronoun

ACADEMIC HISTORY

Name of High School Attended

High School Start Date

High School Graduation Date

Academic Transcripts or Grades

EDUCATIONAL BACKGROUND

Previous Educational Qualifications, if Applicable

Relevant Certiﬁcates or Awards

COURSE FEES AND APPLICABLE DEADLINE

To be conﬁrmed with the VP Academic for each student, based on scholarship eligibility.

SUPPORTING DOCUMENTS

Indicate which documents you are including with your application

Transcripts

Letters of recommendation

CV (optional)

Please submit this application to info@pi-nc.org for further review.

DECLARATION AND SIGNATURE

I, the undersigned, declare that the information provided in this application for enrolment in The Polytechnic Institute of Northern Canada (PI-NC) professional pathway program is true, complete, and accurate to the best of my knowledge and belief. I understand that any misrepresentation or omission of information may result in rejection of my application or, if discovered later, termination of my enrolment. I acknowledge that I may be required to provide supporting documentation to verify the information provided. By signing this declaration, I afirm my commitment to maintaining the accuracy of my application information throughout the admission process and during my enrolment at PI-NC.

Applicant's Signature *

Date *

DATA PROTECTION AND CONSENT

I acknowledge and consent to the collection, use, and processing of my personal data as required for this application for enrollment in The Polytechnic Institute of Northern Canada (PI-NC) CCLP professional pathway program. I understand that the College will handle my personal information in accordance with applicable data protection laws and the College’s privacy policy. I consent to the storage and transmission of my personal data for veriﬁcation of eligibility and admission criteria, communication related to the application and admission process, evaluation of my application, and administrative and academic purposes during my enrollment, if admitted. I also consent to the release of relevant application information to authorised College representatives for evaluation and processing. I understand that I have the right to access, rectify, or request deletion of my personal data in accordance with applicable data protection laws.

COLLEGE CONTACT INFORMATION

For further questions, please contact us at info@pi-nc.org.