Addictions Counselling Program Application

Today's Date
MM slash DD slash YYYY
Name
First Last
Birth Date (mm/dd/yy)
SIN # (for tuition tax credit)
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone (Primary)
Phone (work)
Email
Emergency Contact Name
Emergency Contact Number
Education - Name of High School*
High School Graduation Date (mm/dd/yyyy)*
Education - Name of Post Secondary Institution*
Degree Earned*
Graduation Date (mm/dd/yyyy)*
Please describe your faith journey.*
Please outline your interest in the program.*
Have you been criminally charged in the past 5 years? If so, were the charges sustained? Please explain.*
Course Application Fee
Program Application*
Price:
Students will be contacted by the Admissions Dept.
Application Fee Total
$ 0.00 CAD
Application*
- The information contained in this application is complete and accurate. By submitting this form I affirm my compliance with Emmanuel Community Standards. Community Standards document available here: https://www.emmanuelbiblecollege.ca/about/community-standards/
Method of Payment*
Additional Comments.

Course Application Fee