Student Information Form
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1
2Student Information Form
For Office Use Only
School ____________________________ Date of Registration ___________________
MyEdBC # _________________________ PEN # _______________________________
Grade ____________
Division____________
Student Information
Please Print
Gender
Male
Female
LEGAL Last Name
LEGAL First Name
LEGAL Middle Name
USUAL Last Name
Preferred First Name
Birthdate (DD/MM/YY)
Address
Apt. #
City
Province
Postal Code
Home Phone
Unlisted?
Yes
No
Previous School District
Name of Previous School
Province
Country
Has Student attended a Burnaby school or StrongStart Program?
Yes
No
Name of School
Country of Birth
Citizen of
First Language Spoken
Language Spoken at Home
Aboriginal Ancestry Information Status
On Reserve
Off Reserve
Metis
Inuit
Non Status
Citizenship Status
Canadian Citizen
Permanent Resident/Landed Immigrant
Refugee/Claimant
International
For Office Use Only
International Student – Funding Eligible
International Student Funding Not Eligible
Parents Work Permit - Expiry Date_____________________ Parents Study Permit – Expiry Date_____________________
Parent / Guardian Information
Student lives with
Both Parents
Mother Only
Father Only
Custody Order
Legal Guardian
Other
Parent / Guardian 1
Relationship to Student
Last Name
First Name
Address (if different from student)
Home Phone
Work Phone
Cell Phone
E-Mail
Parent / Guardian 2
Relationship to Student
Last Name
First Name
Address (if different from student)
Home Phone
Work Phone
Cell Phone
E-Mail
Please complete page 2
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Parent category: Business