Academic Planning Registration Form Please complete this form to register. I am thePlease select... Applicant / Student (18 and over) Applicant / Student (under 18) Parent / Guardian Other (18 and over) Your First Name Your Last Name Email Address Home Phone Cell Phone Country Please select... Canada United States ---------------------------- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia ZimbabweCountry where you are currently living. Street Address Address Line 2 City Province/TerritoryPlease select... Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territor Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Is. Guam American Samoa Palau State/Province Postal Code/Zip Code Career Path / Career Interest:Please select... Undergraduate Programs Graduate School Programs Applied Health Sciences Business (Undergrad / MBA) Dentistry Law / OCI / Articling Medicine / CaRMS Midwifery Nursing Occupational Therapy Optometry Pharmacy Physician Assistant Physiotherapy Veterinary Medicine Other Undergraduate Path: Applying to:Please select... Undergraduate Business School Undergraduate Programs - Other Business Path: Applying to:Please select... Undergraduate Business School MBA Admission Securing Employment Dentistry Path: Applying to:Please select... Dental School Admission Residency (Dentistry) Law Path: Applying to:Please select... Law School Admission OCI (On-Campus Interviews) Securing Articling Position Medicine Path: Applying to:Please select... Medical School Admission CaRMS Nursing Path: Applying to:Please select... Nursing School Admission Securing Employment Optometry Path: Applying to:Please select... Optometry School Admission Securing Employment Pharmacy Path: Applying to:Please select... Pharmacy School Admission Securing Employment Physiotherapy Path: Applying to:Please select... Physiotherapy Program Admission Securing Employment Other (Please Describe): Current Education LevelPlease select... High School Pre-College University Program Undergraduate Program College Diploma Program Graduate School Professional School Post Graduate Education Other Graduation YearPlease select... 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 or prior Name of High School High School - Graduation YearPlease select... 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 or prior Undergraduate Program Undergraduate Program - Where is the University/College you are currently attending located?Please select... Canada United States ---------------------------- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe Undergraduate Program - In which province/territory?Please select... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Undergraduate Program - In which state?Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Undergrad - Name of Current University/College - Saskatchewan Please select... First Nations University of Canada University of Regina University of Saskatchewan Other Undergrad - Name of Current University/College - QuebecPlease select... Bishop's University Concordia University École Polytechnique de Montréal HEC Montréal McGill University Université de Montréal Université de Sherbrooke Université du Québec Université Laval Other Undergrad - Name of Current University/College - ManitobaPlease select... Brandon University University of Manitoba University of Winnipeg Other Undergrad - Name of Current University/College - Prince Edward IslandPlease select... University of Prince Edward Island Other Undergrad - Name of Current University/College - British ColumbiaPlease select... British Columbia Open University Malaspina University College Okanagan University College Royal Roads University Simon Fraser University Trinity Western University University College of the Cariboo University College of the Fraser Valley University of British Columbia University of Northern British Columbia University of Victoria Other Undergrad - Name of Current University/College - OntarioPlease select... Algoma University College Brock University Carleton University Lakehead University Laurentian University McMaster University Nipissing University Queen's University Redeemer University College Ryerson University Saint Paul University Trent University University of Guelph University of Ottawa University of Sudbury University of Toronto University of Waterloo University of Windsor Western University Wilfrid Laurier University York University Other Undergrad - Name of Current University/College - Nova ScotiaPlease select... Acadia University Dalhousie University Mount Saint Vincent University Saint Mary's University St. Francis Xavier University University of King's College Other Undergrad - Name of Current University/College - NewfoundlandPlease select... Memorial University of Newfoundland Other Undergrad - Name of Current University/College - New BrunswickPlease select... Mount Allison University St. Thomas University Université de Moncton University of New Brunswick Other Undergrad - Name of Current University/College - AlbertaPlease select... Athabasca University Augustana University College Concordia University College of Alberta The King's University College University of Alberta University of Calgary University of Lethbridge Other Undergrad - Please state the university/college you are attending: Undergraduate - Faculty and Major Undergraduate Program - Graduation YearPlease select... 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 or prior Graduate School Graduate School (GS) - Where is the University/College you are currently attending located?Please select... Canada United States ---------------------------- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe Graduate School (GS) - In which province / territory?Please select... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Graduate Program - In which state?Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau GS - Name of Current University/College - Saskatchewan Please select... First Nations University of Canada University of Regina University of Saskatchewan Other GS - Name of Current University/College - QuebecPlease select... Bishop's University Concordia University École Polytechnique de Montréal HEC Montréal McGill University Université de Montréal Université de Sherbrooke Université du Québec Université Laval Other GS - Name of Current University/College - ManitobaPlease select... Brandon University University of Manitoba University of Winnipeg Other GS - Name of Current University/College - Prince Edward IslandPlease select... University of Prince Edward Island Other GS - Name of Current University/College - British ColumbiaPlease select... British Columbia Open University Malaspina University College Okanagan University College Royal Roads University Simon Fraser University Trinity Western University University College of the Cariboo University College of the Fraser Valley University of British Columbia University of Northern British Columbia University of Victoria Other GS - Name of Current University/College - OntarioPlease select... Algoma University College Brock University Carleton University Lakehead University Laurentian University McMaster University Nipissing University Queen's University Redeemer University College Ryerson University Saint Paul University Trent University University of Guelph University of Ottawa University of Sudbury University of Toronto University of Waterloo University of Windsor Western University Wilfrid Laurier University York University Other GS - Name of Current University/College - Nova ScotiaPlease select... Acadia University Dalhousie University Mount Saint Vincent University Saint Mary's University St. Francis Xavier University University of King's College Other GS - Name of Current University/College - NewfoundlandPlease select... Memorial University of Newfoundland Other GS - Name of Current University/College - New BrunswickPlease select... Mount Allison University St. Thomas University Université de Moncton University of New Brunswick Other GS - Name of Current University/College - AlbertaPlease select... Athabasca University Augustana University College Concordia University College of Alberta The King's University College University of Alberta University of Calgary University of Lethbridge Other GS - Please state the university/college you are attending: Graduate Program - Faculty and Major Graduate Program - Graduation YearPlease select... 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 or prior Professional School Professional School (PS) - Where is the University/College you are currently attending located?Please select... Canada United States ---------------------------- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe Professional School (PS) - In which province / territory?Please select... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon PS - In which state?Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau PS - Name of Current University/College - Saskatchewan Please select... First Nations University of Canada University of Regina University of Saskatchewan Other PS - Name of Current University/College - QuebecPlease select... Bishop's University Concordia University École Polytechnique de Montréal HEC Montréal McGill University Université de Montréal Université de Sherbrooke Université du Québec Université Laval Other PS - Name of Current University/College - ManitobaPlease select... Brandon University University of Manitoba University of Winnipeg Other PS - Name of Current University/College - Prince Edward IslandPlease select... University of Prince Edward Island Other PS - Name of Current University/College - British ColumbiaPlease select... British Columbia Open University Malaspina University College Okanagan University College Royal Roads University Simon Fraser University Trinity Western University University College of the Cariboo University College of the Fraser Valley University of British Columbia University of Northern British Columbia University of Victoria Other PS - Name of Current University/College - OntarioPlease select... Algoma University College Brock University Carleton University Lakehead University Laurentian University McMaster University Nipissing University Northern Ontario School of Medicine Queen's University Redeemer University College Ryerson University Saint Paul University Trent University University of Guelph University of Ottawa University of Sudbury University of Toronto University of Waterloo University of Windsor Western University Wilfrid Laurier University York University Other PS - Name of Current University/College - Nova ScotiaPlease select... Acadia University Dalhousie University Mount Saint Vincent University Saint Mary's University St. Francis Xavier University University of King's College Other PS - Name of Current University/College - NewfoundlandPlease select... Memorial University of Newfoundland Other PS - Name of Current University/College - New BrunswickPlease select... Mount Allison University St. Thomas University Université de Moncton University of New Brunswick Other PS - Name of Current University/College - AlbertaPlease select... Athabasca University Augustana University College Concordia University College of Alberta The King's University College University of Alberta University of Calgary University of Lethbridge Other PS - Please state the university/college you are attending: Professional School Program - Graduation YearPlease select... 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 or prior I am interested in booking an:Academic Planning Session - $200 + tax I am interested in discussing (check all that apply):Profile-Building StrategiesUniversity SelectionExtracurricular, Volunteer, Work ActivitiesGuidance on Course Selection If applicable, please list the schools/organization(s) that are of interest to you at this time: Please indicate how you wish to have your academic planning session conducted. Please choose only one option for each of first choice and second choice: Face-to-face at our Toronto office (located at Yonge and Sheppard)Please select... First Choice Second Choice By Phone/Video ConferencePlease select... First Choice Second Choice When you would like to schedule your Academic Planning Session? Please provide us with several blocks of time/dates that work for you. Please be as specific as you can in terms of your availability. If you want to request a particular date(s), please indicate this as well. Please also ensure that the phone number field above has been completed so that we can call you. Additional Information: Are there are any documents that you would like to discuss during your academic planning session? You will have a chance to upload your document(s) once you submit this form. Once you press "Submit", a link to "Upload Document" will be provided. Examples of documents you may wish to include are: Current Draft of Your Résumé, Transcript, etc. Do you have documents that you would like to discuss with us?Please select... I will upload my document(s) once I submit this form. I want to speak to you to answer my questions before I submit my document(s). Other If you have any concerns or comments for Astroff Consultants (e.g., specific questions at this time), please feel free to use the space below to provide details: How did you hear about us?Please select... Newspaper Internet Search University Student Club Referral I am a previous client Other What is the name of the university student club? Name of referrer: If you have a coupon, gift certificate or are entitled to a promotional discount, please provide details (including your voucher number if applicable): Parent / Guardian Information Please provide the contact information for your parent/guardian so we can obtain his/her consent to register with us. Parent / Guardian First Name Parent / Guardian Last Name Parent / Guardian's Email Address I have read and agree to Astroff's Terms and Conditions and Privacy Policy. Yes! I'd like Astroff to provide me with tips and strategies to maximize my preparation time and improve my profile, as well as information on products, services and promotional offers. I agree that Astroff may contact me by email, telephone and/or text message. I understand that I can unsubscribe at any time. Contact Information
