Canadian College Italy - The Renaissance School: Online Application Form

First Name*

Last Name*

Gender*

female male

Date of Birth* (mm/dd/yy)

Interested in *

Grade 10 Grade 11 Grade 12

Entry Year*

Interested In*

First Semester Second Semester Full Year

Email Address*

Home Telephone*

Address*

Including Postal/Zip Code

City & Country of Birth*

Citizenship*

Passport Number

Passport Expiry (mm/dd/yy)

MOTHERS INFORMATION

Prefix
First*
Middle
Last*
Suffix

Occupation

Home Phone*

Mobile Phone*

Address*

Company Name

Business Phone

FATHER'S INFORMATION

Prefix
First*
Middle
Last*
Suffix

Occupation

Home Phone*

Mobile Phone*

Address (If Different From Above)

Company Name

Business Phone

GUARDIAN INFORMATION (If Applicable)

Prefix
First
Middle
Last
Suffix

Occupation

Home Phone

Mobile Phone

Address

Company Name

Business Phone

Emergency Contact (Name)*

Home Phone*

Mobile Phone*

Send Invoices for Fees to *

mother father both guardian

Send School Reports and Correspondance to:*

mother father both guardian

Names & Ages of Siblings*

Name & Address of Current School*

Last Year's Grade Avg %*

Present Grade Avg %*

Have you ever skipped or repeated a grade? *

yes no

If Yes, which grade?

STUDENT PREFERENCES QUESTIONNAIRE*

Briefly describe your ideal roommate. List the name of your ideal roommate (if applicable)

What are your favorite foods?*

What types of leisure and sporting activities do you prefer?*

Do you have any physical conditions that we should be aware of? (Ex. Food Allergies, Epilepsy, Diabetes) *

Do you have any restrictions with regard to physical activity?*

What is the most important thing we should know about you? *

Why do you think attending CCI would be a positive experience for you?*

List any prescription medication you are currently taking*

List any drug allergies*

Please write a 250 word paragraph explaining why you would like to attend CCI (to be completed by applicant) *

ACADEMIC INFORMATION*

Is your current school semestered?

yes no

Please list the courses you expect to complete by the end of the year*

(If semestered, list the courses by semester)

Have you, or will you, obtain a High School Diploma before attending CCI?*

yes no

If Yes, from which Province or Country?

Will you require an SAT or ACT exam?*

yes no not sure

Do you intend on writing the SAT's?*

yes no not sure

Please list the three current teachers for whom you will request an evaluation*

English

Mathematics/Science*

Third Subject of Choice*

Please Have your Parent or Guardian fill out the Confidential Parent's Form after pressing the Submit button

Please send a confirmation email to the address below*:

Please provide an email address where we can send a link to your current form.

Email Address :