Greater Essex County District School Board

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1 Please print and complete the 4 pages of this application form and return it to the GECDSB Administrative Office along with two (2) certified copies of your most recent report card or school transcripts, (DO NOT SEND ORIGINAL DOCUMENTS), and the application fee of $150 (non-refundable). The cheque or money order payable to the Greater Essex County District School Board. STUDENT INFORMATION Student Surname/Family Name Legal First Name First Name Commonly Used Current Home Address Male Female Birthdate YY MM DD Country of Birth PHOTO Citizenship Local Canadian address (where student will reside in Canada) Canadian Telephone Number address CASL requires that we record your express consent to send electronic messages to you that may contain commercial content. Please choose one of the following: PARENT INFORMATION Parent 1 Full Name Parent 2 Full Name Home Address (if different than student) Parent 1 Telephone Numbers Parent 2 Telephone Numbers Address: CASL requires that we record your express consent to send electronic messages to you that may contain commercial content. Please choose one of the following: Please indicate if student will be travelling and living with parent while studying in Canada.

2 CUSTODIAN INFORMATION (FOR INTERNATIONAL FEE PAYING STUDENTS ONLY) (The Custodian must be over 19 years of age, a Canadian Citizen or a Permanent Resident of Canada and named to assume responsibilities for the student even if the student is accompanied by parent(s)) *Must provide both copies of notarized Custodianship Declaration forms if student is under 18 years of age and not living with parent during their stay in Canada. Custodian s Full Name Custodian s Telephone Numbers Address Business: Address (CASL requires that we record your express consent to send electronic messages to you that may contain commercial content. Please choose one of the following: EDUCATION INFORMATION Present School Attending Name of Principal or Headmaster School Address Last grade completed: Current grade attending: HEALTH INFORMATION Are you in good health and able to participate fully in all school events? Yes If no, please explain: No Does the student have a perceived or documented learning disability, physical handicap, social integration difficulty, behavioural concern or history of criminal behaviour? Yes No If yes, please explain: NOTE: GECDSB does not admit s to Special Education class or other high cost programs

3 SCHOOL PLACEMENT INFORMATION (School placement is dependent on residence, school capacity and English level) Indicate how you heard about ELEMENTARY: SECONDARY: GECDSB? September to June September to June Family or Friend February to June February to December Intended length of stay to study at GECDSB: School Preference: No Preference *Greater Essex County District School Board reserves the right to determine the grade and final school placement GECDSB website Contractor (see below) Other Specify: Education plans following Secondary School: University College Other Specify: CONTRACTOR PLACEMENT INFORMATION (if applicable) (Contractor to complete, if assisted with the application process) Contractor Name: Address: Contact Person: Telephone: Address: CASL requires that we record our express consent to send electronic messages to you that may contain commercial content. Please choose one of the following:

4 Application Information Applications for s in both elementary and secondary for a September start will need to be submitted to the school by June 1 st. For application for second semester (secondary only) will need to be submitted to the school by December 1 st. Submission of application must include the completed application, two certified copies of recent transcript, both copies of notarized Custodianship Declaration forms and $ non-refundable application fee. All information must be complete and accurate to avoid delays in receiving Letter of Acceptance. s must have a valid study permit issued by Citizenship and Immigration Canada, payment of tuition fees, payment of medical fee and complete the English assessment by our Newcomer Reception Office (if applicable) before commencing classes at our schools. Windsor Essex County Health Unit will require an updated immunization record upon commencing classes. It is the responsibility of the student to ensure that their study permit issued by Citizenship and Immigration Canada is valid. Information on study permits can be accessed at Tuition fees are subject to change and are not to be pro-rated for a portion of the month. A nominal school fee may be applicable at the school, covers student card and year book. Tuition and medical fees are due upon arrival at the school. Payment options for tuition fee, due upon arrival at the school, payments can be made by cheque money order or direct payment from bank. 1. Pay in full for the school year 2. Pay half first day of school in September and second half first day of second semester 3. Postdated cheque or electronic withdrawal for the first of every month (September June) 4. Medical fee for mandatory health insurance is due in full first day of school TERMS & CONDITIONS Any inaccuracy in the application is grounds for GECDSB to terminate the agreement and send the student home without refund and at the parent s own expense. A signed Student Participation Agreement is required to be included with the application form We, the undersigned agree that, the information on the application and the attached documents are true and accurate. We understand that if accepted for admission, it will be as a fee-paying student (if applicable), that the monthly tuition fee for the school year and the Board's mandatory medical insurance is payable at the time of the student's arrival to school. Student s Signature Date Parent s Signature Date

5 Application Process Students must: have a Study Permit from Citizenship & Immigration Canada before attending school agree to pay non-resident fees agree to purchase the Board s offered medical insurance 1. The student must first complete and mail an Application form and Student Participation Agreement and attach a cheque or money order for the $ non-refundable application fee payable to the Greater Essex County District School Board (GECDSB). Include two (2) certified copies of your most recent school transcripts Mail to GECDSB Attention Business Department, 451 Park St. W, P.O. Box 210, Windsor, ON, N9A 6K1 2. The application and transcript will be forwarded to the appropriate school in order to receive a Letter of Accommodation. 3. The school forwards the Letter of Accommodation to the Business Dept. at the Board Office. 4. An official letter is returned to the school for the local contact to pick up. The student includes these letters with their application for Study Permit. The Study Permit is obtained before the student enters Canada. 5. International (fee-paying) students must purchase the Board offered medical insurance. Full payment of the medical insurance must be included with the first month s tuition fee before the student attends school. Payment is to be made payable to GECDSB. 6. The student must provide post-dated cheques or pre-authorized payment form for nonresident fees for at least one semester plus full payment for medical insurance as outlined below before being allowed to attend school. 7. Complete and sign the Consent to Photograph and Record and the Field Trip Authorization for s Under Age Schools are to forward payments for non-resident and medical insurance fees to the Business Department at the GECDSB Administrative Office address as per item #1. Non-Resident Fees for the Year School Year**: Elementary Secondary $10, per year ($1, per month) $11, per year ($1, per month) $ 5, per semester Note: Transportation to ESL programs is the responsibility of the student/guardian. Medical Insurance: $500.00* annual fee *payable in full with the first month tuition fee **fees subject to change For assistance please call the Business Dept. of the GECDSB at ext# October 28, 2014