International Student Form @ International Institute of Ayurveda, Toronto, Canada

"WE WANT REAL DREAMERS, NOT SCHOLARS, WHERE SKY IS THE LIMIT".

International Institute of Ayurveda & Complimentary Medicines (IIACM) Inc., Toronto, Canada (Registered & Approved under "Private Career College Act)

(Affiliated with International Council of Ayurvedic Physicians (ICAP) Inc.)

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Ayurvedic Treatments & Services

If you are interested in submitting an international application to International Institute of Ayurveda & Complimentary Medicines (IIACM) Inc., please follow these steps:

Complete the following international education application form
If you wish to clear the fields you filled in, click the Start over button at the bottom of the form
When completed, click the Submit my application button
Finally, if you are providing transcripts or other academic information, mail them to:

IIACM INC.
1115, O'Connor Drive
Toronto, Ontario
Canada M4B 2T5

Tel: 1-416-778-9341

Email: iiacmcanada@gmail.com

You can also print this form.

Note: Required fields are indicated with an *.

Salutation
Part One
* Mr. Mrs. Ms. Miss
* Male Female

Permanent Mailing Address
*Last Name:	(Surname)
*First Name:	Second Name:
*Address:

Apartment #: *City: Province/State:
*Country: Postal Code / ZIP / Pin Code:

Telephone / Fax
Country Code:
Home	- Area/Region Code:	Number:
Work	- Area/Region Code:	Number:	Ext:
FAX	- Area/Region Code:	Number:

E-mail Address:

*Birth Date: *Month: *Day: *Year:

*Country of Citizenship:

Canadian Social Insurance Number (if you have one):

*Preferred Language
English
Other - Please specify:

*Basis for Admission Consideration
Secondary school graduate or equivalent
Age of over 18/19 Years
College/university studies
Please remember to mail or fax original transcripts or certified copies to the address shown above!

Additional Academic Information
Related work experience (please send résumé)

*Have you written TOEFL (Test Of English as a Foreign Language)? (It is not compulsory).
Yes
No

If you answered yes, please provide the following information:

Date written: Month Day Year Your score:

*Type of TOEFL test taken: Paper-based Computer-based

Program Selection (in order of preference)
*1.
*Semester

Authorization

I hereby certify that the above information is true and complete. I understand that any false or incomplete information submitted in support of my application may invalidate my application. I have read the Freedom of Information and Protection of Individual Privacy Statement (see below).

Freedom of Information and Protection of Individual Privacy Act:

The information on this form is collected under the legal authority of the Ministry of Colleges and Universities Act, R.S.O. 1980, Chapter 272, S.S.,: R.R.O. 1980, Regulation 640. The information is used for administration and statistical purposes of IIACM INC. and/or the Ministries and Agencies of the Government of Ontario and the Government of Canada.

*Applicant Signature: By clicking this checkbox, you are agreeing to the terms of the Freedom of Information and Protection of Individual Privacy Act as specified above.

Part Two
How did you first learn about IIACM INC.?
Canadian Embassy	Educational resource in your home country
Education Fair	Friend or Relative in Canada
The Internet	Friend or Relative at home
IIACM Graduate	Educational Publication:
Agent	Other:

Who encouraged you to apply?
School Counsellor	Parent
Agent	Other:

Have you attended school or college in Canada before?
Yes	No

If yes, please list the names and addresses of schools, and the programs and dates attended:
School	City	Program	Start Date	End Date

Future Education and Career Goals
If you are applying for Ayurveda (Full Time Program) or Any other Courses for Academic Purposes, do you plan to continue with any other courses after your first course is completed?
Yes	No
If yes, what programs interest you?


Do you plan to complete a diploma program and go on to university?
Yes	No

Are you planning to work in Canada for one year after graduation (as permitted by Immigration Canada)?
Yes	No

Part 3

If you have a contact person in Canada, please fill out the following section.
Information Release

Pursuant to the Freedom of Information and Protection of Individual Privacy Act, I hereby authorize IIACM INC. to release any and all information related to any and all aspects of my application for admission, acceptance, fees or program of studies to the person whose name and address appears below. I certify that the person named is my selected representative and has my agreement to access and use this information to assist me to successfully register and access programs at IIACM INC.

I authorize information release to my contact in Canada:

Applicant Signature: If you have provided information for a contact in Canada, please read the above terms and click the signature checkbox at left. By clicking this checkbox, you are agreeing to the terms of the Freedom of Information and Protection of Individual Privacy Act as specified above.

Contact's Name and Address
Contact's Name:
Contact's Address:
City:
Province:

Contact's Telephone, Fax and E-mail:
Phone:	Area code:	Number: -
Fax:	Area code:	Number: -
E-mail address:

Have you checked all your entries and verified that they are correct?

Today Date: (yy/mm/dd)