Registration Form - Institute of Executive Studies

Registration Form

Please ensure you provide appropriate information.

Student Information

Name *

First

Middle

Last

As shown in passport

Date of Birth *

Nationality *

Gender *

Male
Female

Mailing Address *

Current School Name *

Schools Location (Town/City) *

Current School Name *

School's Phone *

Current Class/Grade/Form *

Students Email

T-Shirt Size *

Parent/Guardian - Contact Information

Parent/Guardian #1

Full Name *

Nationality *

Residential Address/ Digital Address *

Mailing Address

Town/City of Residence *

Country *

Occupation *

Employer/Business Name

Cell Phone *

Work/Home Phone No. *

Email *

Parent/Guardian - Contact Information

Parent/Guardian #2

Full Name *

Nationality (copy) *

Residential Address/ Digital Address (copy) *

Mailing Address (copy)

Town/City of Residence (copy) *

Country (copy) *

Occupation (copy) *

Employer/Business Name (copy)

Cell Phone (copy) *

Work/Home Phone No. (copy) *

Email *

Child lives with: *

Parents
Guardian
other

(if please provide full name, address and contact information if different from above.)

Phone Number

Do you have any relative(s) living in Canada? *

Has the student been refused a Canadian and/or any other country’s visa before? *

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