FORM A

Please answer all questions as completely as possible.

REGISTRATION INFORMATION
I am applying for:
I am applying for Grade: 9 10 11 12
I will be a: New Student Re-entry Student
I will be: Living in a student residence Living at home and commuting to school
Have you applied to attend CHS before? Yes No

PERSONAL INFORMATION
Prefix: Mr   Ms
Legal First Name: Legal Last Name:
Middle Name: Permanent Mailing Address:
City: Province/State
Postal/Zip Code: Country
Home Phone -- Cell Phone --
Student's Email Address:
Date of Birth (mm/dd/yy):
Citizenship: Canadian US Other: 
Ancestry

Aboriginal Ancestry is determined by reference to the Canadian Constitution Act of 1982 and includes Indian, Métis and Inuit persons of Canada as well as persons who are accepted by one of the Aboriginal peoples of Saskatchewan as a member of their community.
Leave this blank if it does not apply.

   
What was the main factor that influenced you to apply to CHS? Have you visited the campus of CHS? Yes No
If Yes, when or for what event did you visit the campus?    
       

FAMILY INFORMATION
Father's Name: Address:  Same as above or: 
Phone Number:    
Mother's Name: Address:  Same as above or: 
Phone Number:    
Parent's Email Address:    
Have you had any relatives attend CHS, Briercrest College or Briercrest Seminary?
Mother Father Brother(s)/Sister(s) Cousin(s) Aunt(s)/Uncle(s) Grandparent(s)

With whom do you live?
Who has legal custody of you?
 

CHURCH INFORMATION
Do you presently attend church? Yes No If Yes, what church?
Denomination of church: Pastor's name:
Church address: City:
Province/State: Postal/Zip Code:
Phone Number: Email Address:
How long have you attended this church? How often to you attend?
What events or activities are you involved in at this church?
Do your parents attend the same church?   Yes No
Do your parents attend regularly?   Yes No

EDUCATION INFORMATION

What schools have you attended? (Mandatory)

Grade Name of School(s) Type(s) City, Province/State Dates
8 Public Private Home
9 Public Private Home
10 Public Private Home
11 Public Private Home
12 Public Private Home
Have you ever repeated a grade? Yes No If yes, which grade?
Have you ever been expelled /
dismissed from school?
Yes No If yes, for how long?
State circumstances:

 PAYMENT INFORMATION

The application fee is $100 ($150 for international applications)

How will you be paying?:

For credit card payments, please click this link, it will open a new window for payment so you can submit your application.

Interact Email Transfer - instructions

Cheque/money order: Mail to Briercrest College and Seminary - 510 College Drive, Caronport SK, S0H 0S0.

Submissions not paid will not be processed.