Registration Page

CANADIAN COMMUNITY COLLEGE

2451 Clearbrook Road, Abbotsford, BC V2T 2Y1

Application for Training Program Registration

Name of the Training Program ^*

PDF copy

Medium of Instruction ^*

[I] Personal Data

Surname: ^*

Firstname: ^*

Middlename:

Email Address: ^*

[II-A] Residential Address

Street Address: ^*

State/Province: ^*

Country:

Postal Code: ^*

Is your mailing address the same as above? ^*

Yes No

[III] Your Portfolio

Telephone Number:

Home: ^*	() -
Work (Optional)	() -

Your Date of Birth: ^*

Visa Status: ^*

Citizen
Landed Immigrant
Visitor
Others

Student
Refugee
Diplomat

Country of Citizenship: ^*

Education level already achieved:
(Attach details, if necessary) ^*

Type of employment held, if any:

Education/Training goal ^*

Do you have criminal record? ^*

Yes No

Course Selection:

**Fill at least 3

1.
2.
3.
4.
5.

How did you find out about us? ^*

Newspaper Flyers Relatives Friends

[IV] Declaration by the Student


I hereby certify that the information submitted on this form is true and accurate, and that I understand that 
falsification of any documents/info will result in immediate cancellation of my registration or admission at 
the Canadian Community College. Also, I understand that the information provided will be used for the 
sole purposes of registration, admission, resource development, and other purposes, consistent with the 
mandate of this college, and may be shared with appropriate educational agencies.
Additionally, I hereby confirm that I understand that to become a licensed security worker in B.C., I must 
not have any criminal record. (In the case of applicants registering for the BST Program.)

I agree to the terms and conditions mentioned above

Digital Student Signature ^*

(Print your name in here)

Return to main menu