Project Advance

Please Note: All fields are mandatory.

Contact Information

Name:

Address:

Postal Code:

Telephone:

Date of Birth:
(dd/mm/yyyy) / /
Age:
Email:

Emergency Contact Information

Emergency Contact:
Relationship:

Address:

Telephone (daytime):

Telephone (evenings):

Additional Information I am a resident of Ontario Yes No

Session I would prefer: First 2 weeks of July Last 2 weeks of August
I require residence accomodations: Yes No

In September 2011, I plan to attend:
(Name of University/college)

At university/college I plan to major in:
(State area(s) of study)

A personal statement of 250 to 500 words indicating why you want to attend ADVANCE and what goals you hope to accomplish

Check List

I have read and agree to the terms of the Student Informed Consent Form.

My parents have read and agree to the terms of the Parent Informed Consent Form.

I have posted a copy of the psycho-educational report which documents your diagnosed learning disability.

A copy of your high school transcripts which documents your grade average of 65% or higher

A letter of recommendation from an educator at your high school

Documentation that you have had a physical examination within the past six months, indicating any special medical conditions and/or allergies (this report must be signed by your physician)

A $200 cheque or money order payable to Project ADVANCE, York University (refundable pending an 80% attendance record)

You must enter the phrase in the graphic below.