POWELL RIVER INTERNATIONAL STUDENT APPLICATION ONLINE FORM For a printable version you can mail or fax to us, please click here. Family Name:         Given Name/English Name: Address: Birthdate: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Month 01 02 03 04 05 06 07 08 09 10 11 12   1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999             Female     Male Mother's Name:                       Father's Name: Mother's Birthdate (dd/mm/yyyy):         Father's Birthdate (dd/mm/yyyy): Telephone:       E-mail: Education: 1. School:     Dates Attended:     Last Grade Completed: 2. School:     Dates Attended:     Last Grade Completed: I wish to attend:   Grade 6   Grade 7   Grade 8   Grade 9   Grade 10   Grade 11   Grade 12 For a period of:   5 Months   1 Year   2 Years   Longer I wish to graduate from a Canadian High School:   Yes   No I wish to attend a Canadian University in the future:   Yes   No I wish to begin my Canadian studies: (please enter month and year) Activities/Sports/Subjects I Enjoy: Swimming Skating Badminton Volleyball Soccer Basketball Skiing Music Shopping Rock Climbing Tennis Camping Math Video Games Mountain Bike Riding Bowling Billiards Mini Golf Horseback Riding Kayaking/Sailing Reading Science Computer Studies Art Others: I have the following Allergies/Health Concerns: I smoke:     I do NOT smoke: Homestay Preferences: Retired Couple Single Parent Does Not Matter Family with Children Family with NO Children Does Not Matter I like Pets I would prefer NO pets Does Not Matter Prefer to live in town Prefer a rural setting Does Not Matter Emergency Contact:       Relationship: Contact's Address:   Contact's Phone:         Fax:     Email:             Student Info | Participation Agreement | Fees | Student Application Form ABOUT OUR PROGRAM | HOW TO APPLY | ABOUT OUR AREA | CONTACT US CHINESE | JAPANESE | KOREAN | SPANISH | THAI