ESL New Student Registration Form

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ESL Semester Information

* Semester * Year

Personal Information

* First name
* Last/Family name

Gender

Female
Male
I prefer not to identify
I identify as
* Please provide the gender you self identify as
* Date of birth
DD/MM/YY
U of R Student ID number

Citizenship Information

  • International Student
  • Permanent Resident
  • Canadian Citizen
Country of Citizenship

Sponsorship Information

  • Self-funded/No Sponsor
  • Science without Borders / Canadian Bureau for International Education
  • Saudi Arabian Cultural Bureau
  • Libyan-North American Scholarship Program
  • Kuwait Cultural Bureau
  • Other
Other sponsor

Contact Information

* Email address
* Re-enter email address
* Phone number

Permanent Address


This address will appear on your Letter of Acceptance
* Street Address
* City Province/State
* Country Postal/Zip Code

Mailing Address


Same as Permanent Address?
* Street address
* City Province/State
* Country Postal/Zip Code

Emergency Contact Information


Is there someone in Canada we should contact if something happened to you during your studies here?

* Name
* Relationship to you
* Email address * Phone number

Academic Information

Have you attended an educational institution in the past year?
yes no
* Please provide the name of the institution

Visa Information

Have you applied for your Canadian visa?
yes no
Have you already have your Canadian visa?
yes no
Do you have a Government of Canada study/work/visitor's permit?
yes no

Agent Information

I am not working with an agent
Agent name
Agent email

University Information

Do you plan to study at the U of R after you completed the ESL Academic Program?
yes no
Have you already applied for admission to an undergraduate or graduate program to the University of Regina?
yes no
* Faculty of interest

The University of Regina collects information under the authority of The University of Regina Act and in accordance with the Local Authority Freedom of Information and Protection of Privacy Act and the Personal Information Protection and Electronic Documents Act for purposes of the administration of the University and its programs and services. By submitting this form, you are consenting to the University of Regina Residences using your personal information to contact you about and/or administer your Late Move Out request.