UBC UndergradUate admission appliCation

the university of british columbia | vancouverEnrolment ServicesBrock Hall1874 East MallVancouver, BC Canada V6T 1Z1www.students.ubc.caUBC Undergraduate Admission ApplicationIn order to avoid processing delays, applicants are encouraged to use UBC’s online application at you.ubc.ca.This paper application should be used only when the applicant cannot access the online application.NamePersonal InformationMr. Ms. SurnameLegal first nameMiddle nameFormer surnamePreferred nameSuffixAddressStreetCityCountryTelephone (day)Province/StatePostal codeTelephone (evening)Email addressBiographyDate of birth Male FemalePrimary languageOther language(s)Status in Canada (check all that apply)Canadian citizenPermanent resident/landed immigrant of CanadaStudent visaCitizen of (specify country):Date of landing in Canada:Other (please specify):Canadian Social Insurance NumberMature StudentIndividuals who have been outside of full-time formal education for at least four years may wish to apply under the “MatureStudent” admission category after reviewing the information at you.ubc.ca/ubc/vancouver/mature.ezc.Do you wish to apply as a mature student? Yes NoDisabilityYou are encouraged to advise institutions of a disability to assist them in providing appropriate support services.If you would like to indicate a disability, please check this box:Canadian Aboriginal Student Self-IdentificationAre you a First Nations, Métis, or Inuit student? If yes, UBC encourages you to identify yourself as such on your application formso that, if you choose to do so, you can take advantage of a variety of unique resources for Aboriginal students including theUBC Aboriginal admission policy, academic programs, student services, and financial awards.Students who identify themselves as Aboriginal persons will be evaluated in the same manner as every applicant to UBC. If theUniversity finds that an Aboriginal student is not eligible for admission through the general admissions policies, we will considerthe student’s application under the Aboriginal admission policy.ADM_V_UndergraduateAdmissionApplication_1.2_11/10/09_MOOLLAUBC Undergraduate Admission Application Page 1/4

Optional QuestionsAn Aboriginal person is identified in accordance to the Constitution Act of 1982, Part II, Section 35(2), as “an Indian, Métis,or Inuit person of Canada.”Please check this box if you are an Aboriginal person.Please select one or more of the following options that best describe your Aboriginal identity:Indian/First Nations (including Status, non-Status, Treaty, and non-Treaty)MétisInuitThank you for helping UBC support Aboriginal student success and leadership.Indicate the category under which you are applying:Degree/Diploma/CertificateUnclassifiedVisitorNon-Degree StudiesCategoryProgram SelectionYou may choose a maximum of two programs. It is recommended that you select both a first and second program choice justin case you are not admissible to your first program choice. Admission to a degree program does not guarantee entrance to aparticular major or specialization.Program ChoiceFirst choiceSecond choiceCampus (Vancouver or Okanagan)Degree/Diploma/Certificate Program (e.g., BA)Have you previously applied to UBC? Yes No If yes, UBC Student Number (8 digits)When do you plan to begin your studies?Winter Session: (September–April) 20________Summer Session Term 1: (May–June) 20________Summer Session Term 2: (July–August) 20_________Academic HistoryInstructions: Report all secondary (high school) institutions that you have attended (below). Provide information for Grades 9through 12 inclusive.Secondary SchoolsDate of graduation (yy/mm/dd):School name Location (country/city) Grade/level Attended from Attended toPlease carefully review the summary of your academic history for accuracy and completeness. Failure to disclose yourattendance at any school or academic establishment is considered academic misconduct and may result in the withdrawalof any offer of admission, whether accepted or not.British Columbia High School ApplicantsEnter your BC Personal Education Number (PEN) below, if you’ve attended BC Kindergarten to Grade 12 (K –12) since 1993, orwritten a provincial exam since 1986. If you attended a BC public post-secondary institution since 1998, you may have a PEN.To obtain your PEN, contact that institution’s records department. A PEN is not a requirement to complete your application.Please continue if you are unable to obtain your PEN or if you do not have one.BC PEN: (9 digits)UBC Undergraduate Admission Application Page 2/4

Ontario High School ApplicantsIf you are a current Ontario secondary school student applying to Ontario universities and the University of British Columbia,provide your OUAC Reference Number to have your Ontario high school grades transmitted electronically from the OntarioUniversities’ Application Centre (OUAC).OUAC Reference Number: (10 or 11 digits)International Baccalaureate StudentsIf you have an International Baccalaureate (IB) Personal Code, enter it here.IB Personal Code: (6 digits)Post-Secondary Institution InformationReport all post-secondary institutions that you have attended (below).School name Location (country/city) AttendedfromAttendedtoDegree/diplomaearnedDateearnedStudentnumberPlease carefully review the summary of your academic history for accuracy and completeness. Failure to disclose yourattendance at any school or academic establishment is considered academic misconduct and may result in the withdrawalof any offer of admission, whether accepted or not.Have you ever been placed on academic probation, failed an academic year, or been required to withdraw from a college oruniversity?No Yes If yes, please name the institution:COMMENTSIf you would like to provide any additional detail about this application, please do so on an attached sheet.Housing ApplicationUBC Student Housing and Hospitality Services ResidencesWould you like to apply for on-campus residence in:Winter Session (September–April) VancouverWinter Session (September–April) OkanaganYear-round (September–August) VancouverPlease note the residence application fee of $50 CDN is non-refundable and submitting an application does not guarantee aresidence assignment. For your best chance at receiving an assignment, make sure your application and supporting documentation(if applicable) are received by February 1.DeclarationPlease read the following information carefully. You must agree with the declaration before your applicationcan be submitted.Collection and Use of Personal InformationThe University collects, uses, retains, and discloses personal information in accordance with the Freedom of Informationand Protection of Privacy Act (FIPPA), R.S.B.C. 1996, c.165, as amended. Personal information provided on this application iscollected pursuant to the University Act, R.S.B.C. 1996, c.468, as amended, and FIPPA.The information will be used by the University, without limitation, for the purposes of:• admission, registration, graduation, and other decisions on your academic status• operating athletic, residential, alumni, and other UBC-related programs (including issuing UBCcard and U-Pass)UBC Undergraduate Admission Application Page 3/4

The University may share and disclose personal information as follows:• within the University to carry out its mandate and operations• to UBC student societies and UBC Alumni Affairs• to other educational institutions• to professional organizations• to the provincial government• to entities participating in or operating UBC-related programs (e.g., U-Pass)Information may be disclosed to third parties by UBC for statistical and research purposes including, withoutlimitation, to conduct surveys in order to gain feedback from its students regarding their experiences at UBC.The student societies of UBC are the UBC Alma Mater Society and UBC Okanagan Students’ Union and all of theirassociated constituency organizations (“UBC Student Societies”). The UBC Student Societies are separate legalentities from the University.Disclosure of personal information to UBC Student Societies includes full name, student number, year level,faculty of study, membership to organization, and email address.UBC Student Societies use this personal information to:• run elections• manage their membership• administer student programs (including the UBC Alma Mater Society and Graduate Student Society Health & Dental Plan)• communicate with their membershipStudents may indicate whether or not they wish to disclose the above-mentioned personal information to the UBC StudentSocieties on the Student Service Centre (www.students.ubc.ca/ssc).Declaration• I agree that my secondary and post-secondary grades may be released to UBC. I will notify Undergraduate Admissions ofany additional post-secondary studies taken subsequent to the date of this application.• I accept that if, in reading and completing this application, I knowingly or carelessly provided untrue or incompleteinformation, (a) any offer of admission, whether accepted or not, may be withdrawn by UBC; (b) I may be required towithdraw from UBC; (c) I may be subject to academic discipline.• I agree that UBC may verify the information provided by contacting the relevant institution or any secondary or postsecondaryinstitutions not listed in this application.• I accept that information on falsified documents is shared with the Association of Universities and Colleges of Canada.• I agree that my name may be released to my school or school district if I am a scholarship recipient.• I agree, if admitted to UBC, to comply with the UBC Calendar and all the rules and regulations of the University, presentand future.For more information, contact the Registrar of the University of British Columbia.Signature of applicant:Date:Application PaymentYour admission application will not be processed until the non-refundable application fee is paid.Application fee for domestic (Canadian andpermanent residents) applicants: $60Application fee for international applicants: $100Housing application fee: $50Name of cardholderSignature of cardholderChequeDraftMoney orderCredit card (Visa and MasterCard only)Card typeCard security codeCard numberExpiry date (mm/yy)Amount authorizedUBC Undergraduate Admission Application Page 4/4