YRDSB Academic Application

1 Page 1 of 4 (2018 Nov)STUDENT INFORMATIONLAST NAME PLEASE PRINT CLEARLY AND IN BLACK INKFIRST NAMEAGECOUNTRY OF BIRTHCITIZENSHIPEMAIL ADDRESS (MANDATORY)MALESTREET ADDRESSPRIMARY TELEPHONE NUMBER (include area code)PRIMARY EMAIL ADDRESS (MANDATORY)CITYCOUNTRYPOSTAL CODEPROVINCESTREET ADDRESSHOME TELEPHONE NUMBER (include area code)CELL-PHONE NUMBER (include area code)EMAIL ADDRESS (MANDATORY)CITYLAST NAMERELATIONSHIP TO STUDENT (MANDATORY)FIRST NAMEPARENT AND FAMILY INFORMATIONFATHER S LAST NAME CELL TELEPHONE NUMBER (include area code)EMAIL ADDRESS (MANDATORY)MOTHER S LAST NAME CELL TELEPHONE NUMBER (include area code)EMAIL ADDRESS (MANDATORY)FEMALEOTHER NAME USEDOCCUPATION/TITLEOCCUPATION/TITLENAME / AGE OF SISTER(S) OR BROTHER(S)CUSTODIAN INFORMATION - REQUIRED IN ALL CASES(in home country)(if different than custodian)STREET ADDRESSPRIMARY TELEPHONE NUMBER (include area code)CITYPOSTAL CODEPROVINCELAST NAMERELATIONSHIP TO STUDENTFIRST NAMEFATHER S DATE OF BIRTH MOTHER S DATE OF BIRTHWILL THE STUDENT LIVE WITH A PARENT WHILE S/HE IS STUDYING IN CANADA?

2 WITH WHOM WILL THE STUDENT LIVE? MOTHER FATHEROTHER (SPECIFY):EMAIL ADDRESS (MANDATORY)WORK TELEPHONE NUMBER (include area code)WORK TELEPHONE NUMBER (include area code)POSTAL CODEPROVINCEI nternational Visa Student Academic ApplicationInternational Education Services36 Regatta AvenueRichmond Hill, ON L4E 4R1 : (905) 884-3434 Fax: (905) CONTACT INFORMATION IN CANADA(Must be a Canadian Citizen or Permanent Resident over age 25 and assume the role of official contact for the school.)YESNODOB (YYYY MM DD)FATHER S FIRST NAMEMOTHER S FIRST NAME YYYYMMDD YYYYMMDDIF NOT LIVING WITH PARENT(S), THE STUDENT MUST LIVE WITH RESPONSIBLE ADULT(S) IN A HOME ANY MEDICATION(S) PRESCRIBED TO THE PLACEMENTLIST SCHOOLS IN ORDER OF PREFERENCE: (please visit to view the list of available schools) ELEMENTARY STUDY PLANPROGRAM AREA OF INTERESTSEPTEMBER FEBRUARY GRADE PLACEMENT STARTING SEMESTER 2 SEMESTERSOTHER:DURATION OF STUDYCHOICE BY MUNICIPALITIES: 1.

3 AURORA3. GEORGINA5. MARKHAM7. RICHMOND HILL2. EAST GWILLIMBURY 4. KING 6. NEWMARKET8. VAUGHANBUSINESS ARTS MATHEMATICSENGLISHSCIENCECOMPUTER STUDIESSOCIAL SCIENCEOTHER (SPECIFY):9. WHITCHURCH-STOUFFVILLEEDUCATION GOALSONTARIO SECONDARY SCHOOL DIPLOMA AT TEND UNIVERSITY IN CANADA ONTARIO SECONDARY SCHOOL CREDITSAT TEND COLLEGE IN CANADAOTHER: HOW DID YOU HEAR ABOUT YRDSB ?EDUCATION FAIRFRIEND / RELATIVE AGENT / AGENCY INTERNET International Visa Student Academic Application (AVAILABLE ONLY IF YRDSB CUSTODIAN & YRDSB HOMESTAY IS SELECTED)AIRPORT PICK-UP SERVICENOT REQUIREDNO PREFERENCE13 MONTHSPage 2 of 4 (2018 Nov)LIST ANY MEDICAL CONDITIONS THAT SCHOOL STAFF SHOULD BE AWARE OF.

4 FOR EXAMPLE, ADD/ADHD (ATTENTION DEFICIT, HYPERACTIVITY DISORDER), ANXIETY, DEPRESSION, Admissions Office will make every attempt to place students in their preferred school of choice; however, this is not always possible. York Region District School Board reserves the right to determine the final school and grade placement. In the Ontario education system, an elementary school student is placed in a grade according to their year of birth. It is common for the secondary school student who is designated to a particular grade to take subjects at a different grade level as long as s/he meets the subject NOT REQUIRED TO REQUEST YRDSB TO ARRANGE HOMESTAY & CUSTODIANSHIP COMPLETE THE STUDENT HOMESTAY/CUSTODIANSHIP Application (NOTE: YRDSB Custodianship and YRDSB Homestay is available to students entering Grade 9 to Grade 12) (COVERAGE MUST BE FOR THE ENTIRE SCHOOL REGISTRATION PERIOD)REQUIRED12 MONTHSHOMESTAY/CUSTODIANSHIPMEDICAL INSURANCEMEDICAL INFORMATIONThe medical insurance coverage provided to YRDSB international students is subject to limitations and exclusions.

5 Students who require care for unstable or chronic/ongoing conditions will have to pay for medical treatments directly. REFUND POLICYDEFERRAL OF FEESIf a study permit is not issued in time for the student to attend the first day of classes, the student may request that admission be deferred to the following semester. If the study permit is not issued within two (2) weeks following the commencement of classes, fees will automatically be deferred to the following a Study Permit is refused and the student wishes to re-apply, rather than requesting a refund, the student may request that admission be deferred to the following semester. The request for deferral must be submitted in writing within 30 days of denial of the Study Permit.

6 A copy of the original refusal letter from Immigration, Refugees & Citizenship Canada (IRCC) must accompany the written requestA refund is issued only if a student is refused a Study Permit by Immigration, Refugees & Citizenship Canada (IRCC). In this case, the student must submit the following documentation within 30 days from the issue date of the original refusal letter from IRCC: a written refund request signed by the parent(s) and student indicating to whom the refund cheque should be made payable a copy of the original letter of refusal received from IRCC the student withdraws for any reason after a YRDSB official Letter of Acceptance has been issued the student is found in violation of YRDSB policies or the Student Code of Behaviour and is asked to withdraw from school false medical information is given and/or pertinent medical conditions are not disclosed no partial refund will be issued in the case of late arrivalInternational Visa Student Academic ApplicationPage 3 of 4 (2018 Nov)

7 APPOINTMENT OF AGENCYSTREET ADDRESSTELEPHONE NUMBER (INCLUDE AREA CODE)SIGNATURECITYCOUNTRYPOSTAL CODEAGENCY INFORMATIONCONTACT PERSON S NAMECELL PHONE NUMBER (INCLUDE AREA CODE)EMAIL ADDRESS (MANDATORY)DATE (YYYY/MM/DD)PROVINCE(if applicable)SIGNATURE OF PARENT:DATEI/We authorize the Agency named below to serve as our representative and to share and receive information regarding this Application on our behalf with the York Region District School PERMIT REFUSAL an administration fee of $500 will be deducted from each refund requestNo refund will be issued if the student fails to submit any of the above within 30 days from the issue date of the original refusal letter from IRCC:COMPANY NAMEDATESIGNATURE OF PARENT:STATUS CHANGEIf the immigration status of a student changes prior to or during the school year, contact the Reception Centre to have immigration documents verified.

8 To request a refund of fees, please contact International Education Services. Please note that requests for refund will not be considered if received after October 15 for semester/term 1 or March 15 for semester/term 2. An administration fee of $500 will be deducted from each refund Fee, Homestay/Custodianship Application Fee, Custodianship FeeIf a refund request is approved, please note the applicable fees that are refundable and :Refundable:APPLICABLE FEESMEDICAL INSURANCEA refund of the medical insurance fee may be requested directly from Ingle Travel & Health Insurance Services Inc. by telephone at 1-888-386-8888 or by email Fee, Homestay Fee, Airport Pick-upNo refunds will be issued in the following circumstances:PARTICIPATION AGREEMENTSIGNATURE OF PARENT:DATEDATESIGNATURE OF STUDENT (Over age 18): International students must comply with all York Region District School Board policies and the Student Code of Behaviour.

9 Failure to follow school policies or to comply with the conditions of the study permit (make progress toward completing the program) as stated by Immigration, Refugees & Citizenship Canada (IRCC) will result in withdrawal from the program. No refunds will be granted if students are demitted for any of the above students must have achieved an Academic average of 65% and must maintain this average while attending school in order to be eligible for admission school students must maintain a full-time timetable (minimum of three (3) courses per semester).Students must notify the Admissions Office of the York Region District School Board, and the school's main office of any changes to: custodian by providing updated Custodian Declaration documents, contact information, and living arrangements.

10 International students are not eligible to participate in special programs such as Special Education, the French Immersion Program, the International Baccalaureate Program, the Sports Program at Bill Crothers Secondary School, the Arts Unionville Program, and any regional arts, sports and music programs. All in-school programs are open to student who will reach 18 years of age while participating in the program must provide consent to share school record information by signing a Consent for Information Sharing - Students at the Age of Majority OF PARENT:DATEI nternational Visa Student Academic ApplicationPage 4 of 4 (2018 Nov) (must be acknowledged, signed and dated by both student (over age 18) and parent(s))Student photographs, video taped images and activities, voice recordings, artwork, writing or other school work may be recorded, displayed or used in board and school specific Internet web pages for documentation and presentation purposes of the York Region District School Board.