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Name Surname (family name), First (given names)
Last School Attended
Citizenship
Visa Student?  Yes  No
Homestay required?  Yes  No
Sex Male  Female
Street
City
Province/State
Country
Postal Code
Phone
Fax
Email
Date of Birth
  Style:1980-01-01
Place of Birth
Parent family name
Parent Tel #
  Program Choice
University Transfer
Senior High School Programs
English Studies Certificate Program
English Short Term Program
  Semester of First Enrolment
Spring Semester
Summer Semester
Fall Semester

REQUIRED ENCLOSURES WITH THIS APPLICATION

There is an application fee of 100 dollars in Canadian funds. You will also need to submit the following to our office before your application can be completely processed:
 

1. Your official transcript(s).

2. One passport size photo.

3. Your TOEFL score, if available.

At Coquitlam College, we feel that extra-curricular activities are an important part of the College's programs and that all students benefit greatly by participating in them. Please check any boxes for activities that you DO NOT want your son/daughter to participate in.  

Basketball Camping Skiing Volleyball
Floor Hockey Hiking Ice-Skating Badminton
Baseball Water Sports Snowshoeing Soccer
Horseback Riding Whale Watching Snowboarding Field trips Trips

IT IS MANDATORY THAT ALL STUDENTS HAVE MEDICAL INSURANCE

If students do not have medical insurance upon entering Coquitlam College, the College will enroll students in a private medical plan at a cost of $188.00 per semester. Following this, students may apply for British Columbia Medical Plan insurance after residing in British Columbia for three months.

 There is an application fee of 100 dollars in Canadian funds.
Type of Credit Card
Name on Credit Card
Card Number
Expiry Date  MM/YYYY

By clicking on "Submit" below, you are declaring that the information in this application is, to the best of your knowledge, complete and correct.