Student Intake Form

Thank you for your interest in our immigration services. To ensure your enquiry reaches the right team and receives the attention it deserves, we kindly ask that you complete our short assessment form. This helps us understand your needs and connect you with the appropriate specialist. We look forward to assisting you.

VisaOne Canada Inc. — International Student Intake Form

01Personal Information

Full Name (as per Passport)

Date of Birth (DD/MM/YYYY)

Gender

Male
Female
Other / Prefer not to say

Country of Citizenship

Current Country of Residence

Full Residential Address

Phone Number (with country code)

Email Address

02Emergency Contact

Full Name

Relationship

Phone Number

Email (optional)

Country

03Academic Background

Highest Level of Education Completed

Institution Name

Country of Study

Year Completed

English Proficiency Test Type

Score

04Program Selection

Field of Study

Program Applying For

Preferred Start Date

07Supporting Documents

Tick the documents you will attach with this application.

Upload files (optional — PDF/JPG, max 10MB each)

09Declaration

I certify that the information provided is accurate and complete. I understand that
providing false information may result in refusal or cancellation of admission.

I confirm the declaration above is true.

Student Signature (type full name)

Date

Your information is kept confidential and used only for admission processing.

Student Intake Form

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