International Student Application for Admission

*How did you first learn about MBCI?

If through an Agency, please list Agency name and contact

If Other, please list

Student Information

*Applying for Grade	*Beginning	Year
*Legal Surname	*Legal First Name	*Legal Middle Name
*Name Commonly Used	*Gender	*Country of Birth
*Citizenship	Birthdate
Applicant's Sibilng Name	Grade	Current School
Applicant's Sibilng Name	Grade	Current School

Home Address

Apt.	*House/Building Number	*Street
*City	*Province/State	*Postal Code
*Country	*Home Phone	*Home Email

Father/Guardian Information

Title	*Birthdate
*Surname	*Given Name	Apt.	*House/Building Number
*Street	*City	*Province/State	*Country
*Postal Code	*Home Phone	Business Phone	Cell Phone
*Email Address	*Occupation	*Employer	*Position

Mother/Guardian Information

*Title	*Birthdate
*Surname	*Given Name	Apt.	*House/Building Number
*Street	*City	*Province/State	*Country
*Postal Code	*Home Phone	Business Phone	Cell Phone
*Email Address	*Occupation	*Employer	*Position

Contact Person in Home Country or Canada (if different from above, example sending Agency)

Name	Apt.	House/Building Number
Street	City	Province/State
Country	Postal Code	Home Phone
Business Phone	Cell Phone	Email Address

Homestay and Custodianship

Citizenship and Immigration Canada requires that each student have a Custodian in the community. The Registrar of MBCI will be the custodian for all students in our homestay program. Please indicate which of the following two options you would like for homestay

Homestay Option One - I will arrange my own homestay

Homestay Option Two - Please arrange a homestay for me

Please provide the following information about your homestay family
*Name	*Street Address	*City
*Postal Code	*Home Phone	*Business Phone
*Cell Phone	*Email Address	*Relationship to Student

MBCI Homestay families are required to respect and support the goals and values of MBCI. All of our Homestay Families provide a non-smoking environment. For the purposes of finding you the best possible homestay match, please answer the following questions:

*Have you ever been away from your family for long periods of time?

If yes, please indicate the length of time

*Are you allergic to any animals?	If yes, please specify
*Do you have any special dietary requirements? (e.g vegetarian, vegan)	If yes, please specify
What kinds of food do you like to eat?	What kinds of foods do you dislike

*What words describe your personality? (select all that apply)

*What activities do you enjoy? (select all that apply)

If other, please specify

Church Information

*Do you belong to or practice any religion?

If yes, please specify

Education and School Placement

*Current Grade	*School Currently Attending
*Start Date	*End Date
*School Website	*Contact Name
*Previous School	*Start Date
*End Date	*Grade Completed
*How long do you plan on studying in Canada?	If several months selected, please indicate how many
*What are your goals after you complete your studies in our Program?
If Other, please specify

English Ability

*Please indicate how many years you have taken formal English classes at school	*Please indicate how many years you have taken formal English classes through Private Lessons
*When do you speak English?

Emergency Contact Information

Emergency Contact Information (please provide two contacts in home country)
Emergency Contact Number One
*Name	Apt.	*House/Building Number
*Street	*City	*Province/State
*Postal Code	*Country	*Home Phone
*Business Phone	*Cell Phone	*Email Address
*Relationship to Student
Emergency Contact Number Two
*Name	Apt.	*House/Building Number
*Street	*City	*Province/State
*Postal Code	*Country	*Home Phone
*Business Phone	*Cell Phone	*Email Address
*Relationship to Student

Medical Information

*Allergies (n/a if none)	Please indicate if the listed allergies are any of the following
Symptoms of reaction	Action required
*Please list all medications taken and why	*Other relevant medical information/conditions

Vaccinations

*Please upload a copy of your vaccination record

Medical Consent:
I/We as parent(s)/guardian(s) of the undersigned student do hereby authorize the MBCI International Student Program staff and the sponsoring Homestay parents to consent to any X-ray examinations, anesthetic, medical or surgical diagnosis or treatment or hospital care which is deemed advisable by, and is rendered under the general supervision of any licensed physician or surgeon, whether such treatment or diagnosis is rendered at the clinic of said physician or surgeon or at a hospital.

It is understood that this authorization is not given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of the MBCI International Student Program to give specific consent to any and all such diagnoses, treatment, or hospital care which the aforesaid physician or surgeon in the exercise of his/her best judgment may deem advisable.

Student Responsibilities:

I understand that a successful experience in the International Student Program at the Mennonite Brethren Collegiate Institute (MBCI) depends upon regular class attendance, completion of all homework and assignments and participation in all activities offered by the program. I acknowledge that the International Student Program of MBCI reserves the right to dismiss students and return them home, at their expense, without tuition refund for violating any of the rules set out by the program (see the refund policy at http://mbci.mb.ca/parents/admissions/international-student-program.)

I understand that serious breaches of program rules include, but are not limited to:
• Driving a motor vehicle
• Inappropriate use of social media, eg. Facebook, Instagram
• Engaging in any illegal activities
• Not maintaining the minimum course load
• Violating the rules set out in the MBCI Code of Conduct
• Using alcohol or illegal drugs
• Breaking homestay rules
• Unauthorized travel outside of Winnipeg
• Holding a paying job

I agree to abide by the program regulations and to cooperate with administrators, teachers and students at MBCI.

Parental Responsibilities:

I/We understand that success in the International Education Program at the Mennonite Brethren Collegiate Institute (MBCI) depends upon my/our child’s willingness to adhere to the Program rules and regulations. I/We also understand that, if my/our child violates any of the Program rules and regulations, she or he may be removed from the Program and sent home, at my/our own expense, and without tuition refund.

By my/our selecting the checkbox below, permission is granted as follows:

1. For my/our child to participate in any field trip(s) and outings arranged by the school or the International Student Program;
2. To use photographs of my/our child, that may be placed on the MBCI website, social media pages and/or used in promotional materials.
3. To use students writings (quotes, stories etc.), which may be placed on the MBCI website, social media pages and/or used in promotional materials.

*I/we have read and agree to the above Medical Consent, Student Responsibilities and Parent Responsibilities

To complete your application, please submit the following files:

*Select your certified translated copies of your current school year report card

*Select your certified translated copies of your previous school year report card

*Upload a 200-400 word essay in English, written unassisted by the student, about themselves, their lifestyle, culture and interests

*Please submit a passport size photo

*Please submit a photocopy of your passport

*Please submit one letter of recommendation from a teacher or school principal

*I agree