New International Student

Information Sheet
PLEASE PRINT CLEARLY

Campus: ViProgress [ ' Morningside D Ashton bee D SAC D ELS D Downsview

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Student Number: [3U_[ _?>_~-~~q::Q~g _- _ ___, UCI*:

Name: ™JJLV_:w-·-r.1Ny H-~- I

Canadian Address : 11'-i-Hf_$ (.Q:f =~(:_jJlC::.L_l - ,Bf~__IO,V t- 0 f\J I
[£RAfvfe1<i._7Sl _ Province: c--o-1\}
City: I Postal Code: I l , bRa M:R
[LC[_J E-mail: I !3<'.W>l,-,m;M,ba;n;.;;:oLciJC '1.1l@ g"i'n£1 ,(,lj
Phone Number I (6\fj fs J Q_] C

Emergency Contact in Canada

Name: L~ _ I
Address : [I_\_;.I f ~~~~:-=-~ -~ ( 'D=L.. .I:_
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Phone Number: cu; (:( f)1:etr=:l,F7l;t[] Relationship to the student: ~ J i ., . !

Emergency Contact Back Home

Name __,____,_A
Address: i_ _ _h,AJ.,0 / ---~ -~ -- -·- _ 1.L-~l.a!Li'.\-+_..11..,£1&!...jlC:,,,µ;,1.4,t-,~ VA,,~~

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Phone Numb~;, - ~ TJ l'fFf[()_[ffi_J ~xu1 :r J
Relationsh ip to the student: : · . ~f«).~ ____ j

UCI* - User Cl ient ID can be foun d on t he

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