Please Check One: Practical Nursing Program
Opticianry Program
Seneca Student ID: Date of Birth:
Last Name: First Name:
Street Address: Apt./Unit#:
City: Province: Postal Code:
Home Phone: Other Phone:
Seneca Email: Other Email:
Initial Below I confirm my understanding of the following:
I will be notified of acceptance into the program by email.
I must receive the confirmation letter of acceptance (by email) BEFORE registering for professional
Opticianry or Nursing specific subjects at Seneca. (I may register for general education subjects at
any time.)
If transferring professional Opticianry subjects from another institution, I may only apply for transfer
credit for professional subjects AFTER receiving my formal letter of acceptance by email. (General
Education subjects may be transferred at any time.)
Faculty of Continuing Education
10-15
Seneca
Admission Request Form
Requirement Name of attached supporting document or transcript
English: Grade 12 (C) or ENG4 (U) or College English
Physics or Chemistry Grade 12 (C)
Mathematics Grade 11 (U) or (M) OR Grade 12 (C)
Biology Grade 11 (C)
Signed: Date:
Faculty of Continuing Education OFFICE USE ONLY:
Date stamp and forward to:
Practical Nursing Program - Deanna MacDonald, Program Assistant
Opticianry Program - Maria Graziosi, Program Assistant
FREEDOM OF INFORMATION AND PROTECTION
OF PRIVACY ACT
Personal information on this form is collected in accordance with
sections 21, 39 and 49 of the Freedom of Information and Protection
of Privacy Act and under the legal authority of the Ministry of Training,
Colleges and Universities Act, R.S.O. 1990, and the Ontario Colleges
of Applied Arts and Technology Act, 2002, Regulation 34/03, and may
be used and/or disclosed for administrative, statistical and/or research
purposes of the College and/or the ministries or agencies of the
Government of Ontario and the Government of Canada. If you
have any questions concerning the collection and use of personal
information, please contact the Privacy Office at (416) 491-5050
extension 77846 or email privacyoffice@senecacollege.ca.
mm/dd/yy
Listed below are entry requirements to process this application. PROOF of attained credits must be attached.
yy/mm/dd
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