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Post Grad B-Tech Diploma

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818 Cousens Terrace ● Milton, ON● L9T 0G1 ● CANADA
Phone:(647) 500 7011 ● Fax:(905) 785 7011 ● E-Mail:Info@ICEunlimited.com
www.ICEunlimited.com

STUDENT PROFILE

Please be aware that ICE Inc. may need to contact you for additional information. When we receive the completed form we will begin researching institutions that match your preferences. If you have any questions feel free to contact us.

A. PERSONAL INFORMATION

	Last Name		First Name			Middle Name
Address
City	State/Province		Postal/Zip Code			Country
Home Phone (Incl. Country code)		Cell Phone (incl. country code)		E-mail Address
Date of Birth (MM/DD/YYYY)			Country of birth
Do you have a valid passport?			Yes		No
Have you ever applied for a student visa for US/ Canada?			Yes		No
Were you ever granted a student visa?			Yes		No
Were you ever denied a student visa?			Yes		No
Do you have relatives in US/Canada?			Yes		No

B. ACADEMIC INFORMATION
Provide a summary of educational institutions attended starting with current or most recent. (provide copy of scores/marksheets)

Institution Name	City/Country	Dates attended (MM/YY) From To	Diploma/Degree awarded




Scores:
SAT(Total) SAT(Verbal) TOEFL LSAT TSE USMLE
SAT(Math) ACT IELTS GMAT GRE Other
Clubs/Organizations participated in
Sports participated in
Awards received
How do you plan to finance your education?

Are you applying for the TRIOS College, one-year Post Graduate B.Tech. Diploma? YES (Skip Section C)
NO (Complete Section C)

C. NEED HELP MAKING YOUR DECISION?
Answer the following questions and let us find an institution that best matches your needs.

When do you plan to commence studies?		I'm ready within 6 months within 12 months next 1-2 yrs
What type of program are you looking for?		Diploma/Associates Bachelor Masters Doctorate
Preferred region of study	Canada	USA	No Preference
Preferred type of campus	Rural	Small Town	Suburban
	Urban	Downtown	No Preference
Preferred student size at campus	<1,000	< 5,000	<10,000
	<20,000	No preference
Institution type	Co-ed	Women only	Men only
List the major or field you are interested in pursuing? (Undecided is an acceptable choice)		1^st choice 2^ndchoice 3^rd choice
List the names of preferred Institutions (if any)		1^st choice 2^ndchoice 3^rd choice 4^thchoice 5^thchoice
List any clubs or associations you would like to participate in
List any sports you would like to participate in
List any special requirements or mental/physical challenges

Notes/Comments (if any)

All information provided to ICE Inc. and/or its educational partners will be treated in strictest confidence and will not be divulged to any third party without your consent other than educational providers.
I declare that the above information is true and complete. I understand that any false, misleading or incomplete information in support of my application may invalidate it.

Signature
(Please Enter Initials)
Date: April 13, 2005

Please enter the number exactly as seen above

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