UNDERGRADUATE APPLICATION FORM

UNIVERSITY OF BRITISH COLUMBIA (UBC)

PERSONAL INFORMATION
Please change “ä, ö, ü and ß” into ‘ae, oe, ue and ss’
First Name(s):
Middle Name(s):
Preferred First Name:
Family Name:
Former Surname:
Date of Birth: Month: Day: Year:
E-mail Address:

Would you like to be Yes*

contacted by email? No
*By selecting yes, I am agreeing to receive emails from the
University of British Columbia about admissions and programs,
prospective student events and visits, campus tours, as well as
other valuable information about the application process. I
understand that I can change my communication preferences at any
time.

Intended Start Date:

Country of Residence:

What is your status in Visitor

Canada? Study Permit
(Please check on the IEC website on the UBC
profile under “Visum” what this means)

How did you hear

about UBC?

Please note:
IEC uses UBC’s online application tool to submit your application. In order to submit
your application we need to provide an answer to the following “Security Question”:
What was your childhood nickname? ____________________________________________

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TERMS OF USE
Please read and agree to the following “Terms of Use”. IEC cannot submit your
application if you do not agree.

Your use of UBC computing facilities, including CWL accounts [used to submit online
applications], is subject to and expressly conditioned on your acceptance, without
modification, of these Terms of Use ("Terms of Use"), as may be amended from time to
time by The University of British Columbia ("UBC").

By checking "I Agree" below, you state that:

1. you agree not to use UBC's computing facilities or your CWL account in any way
that is illegal, or to do things that are illegal (including infringing copyright);
2. you agree to abide by all of UBC's Policies and Procedures, as they may be
amended and renamed from time to time, including but not limited to Policy #104
(http://www.universitycounsel.ubc.ca/policies/policy104.pdf) and all other policies
on responsible use and security of UBC's electronic information and systems;
3. you acknowledge that you have read, understood and agree to abide by the
applicable requirements set out in UBC's copyright website
(http://copyright.ubc.ca) as they may be amended from time to time, including but
not limited to: The Copyright Requirements for UBC Faculty and Staff
(http://copyright.ubc.ca/requirements/copyright-requirements/); and The Fair
Dealing Requirements for UBC Faculty and Staff
(http://copyright.ubc.ca/requirements/fair-dealing/); and
4. you acknowledge that you have read and understood the guidelines posted on
UBC's copyright website, including but not limited to: The Copyright Guidelines for
UBC Faculty, Staff and Students (http://copyright.ubc.ca/copyright-guidelines-for-
faculty-staff-and-students).

Any failure to comply with the foregoing or with any other aspect of these Terms of Use
may result in the suspension of computing privileges, suspension of your CWL
Account, and other applicable penalties or discipline.
If you do not agree with any part of these Terms of Use, click "I do not agree" below or
cancel out of this application, and contact [email protected]. However, by actually
using UBC's computing facilities and/or your CWL Account, you are bound by these
Terms of Use. UBC reserves the right to change or modify any of the terms and
conditions contained in these Terms of Use at any time and in its sole discretion. Any
changes or modifications will be effective upon posting of the revisions to UBC's
website. Your continued use of your CWL account following the posting of any such
changes or modifications will constitute your acceptance of such changes or
modifications. You should review these Terms of Use regularly to ensure that you
remember and understand the terms and conditions that apply to use of your CWL
Account.
These Terms of Use shall be governed by the laws of the Province of British Columbia,
Canada without regard to its conflict of law provisions. You consent and submit to the
exclusive jurisdiction of the courts located in the Province of British Columbia, Canada,

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in all disputes arising out of or relating to the use of your CWL account and these
Terms of Use.

MORE INFORMATION: For more information, please refer to the Campus-Wide Login -
More Information Document
(www.it.ubc.ca/service_catalogue/accounts/cwl/moreinfo.html). It has further details
on information collected, personal information you choose to share, and the CWL
security measures.
CONTACT US: To report the abuse of these facilities or for further assistance, please
contact the IT Service Centre Help Desk online at www.it.ubc.ca/helpdesk or call 604-
822-2008.

I agree to the Terms of Use as stated above.

BIOGRAPHICAL INFORMATION

Country of Citizenship:
Did you complete an Yes – Personal Code:
International _______________________
Baccalaureate (IB)? No
Male
Gender Female

ADDRESS
Mail communication from UBC will be sent to this mailing address. Please ensure its accuracy. If
your semester address is subject to change, insert your parents’ or another permanent address!

Street Name & Number:

City:
State/Province:
Country:
Postal Code:
International phone
number: (e.g. +49 …)

DISABILITY
You are encouraged to advise UBC if you have a disability, so that we might assist you
with appropriate support services.

I would like to indicate a disability:

______________________________________________________________________

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ACADEMIC HISTORY

Secondary (High) School(s)

Name of High School 1:
Street Address:
State / Province:
City:
Postal Code:
Country:
Attendance Dates
From To
(Month/Year):

Name of High School 2:

Street Address:
State / Province:
City:
Postal Code:
Country:
Attendance Dates
From To
(Month/Year):

Post Secondary (University / College) Institution(s)

Name of Institution 1:
Street Address:
State / Province:
City:
Postal Code:
Country:
Attendance Dates
From To
(Month/Year):
Study Program:
e.g. Bachelor of
Sciences in Economics

Name of Institution 2:
Street Address:
State / Province:

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City:
Postal Code:
Country:
Attendance Dates
From To
(Month/Year):
Study Program:
e.g. Bachelor of
Sciences in Biology

Please carefully review the summary of your academic history for accuracy and completeness. Failure to
disclose your attendance at any school or academic establishment is considered academic misconduct and
may result in the withdrawal of any offer of admission, whether accepted or not.

GENERAL APPLICANT INFORMATION

Have you previously applied to UBC?
Yes – When and for what?
______________________________________________________________________
No

What year level do you think you will be entering at UBC?

Year 1 (less than one full-time year of post-secondary study completed prior to
May)
Year 2 (one full-time year of post-secondary study completed prior to May)
Year 3 (two or more full-time years of post-secondary study completed prior to
May)
Year 4 (I have completed an undergraduate degree and would like to pursue a
second degree)
Year 5 Unclassified (have completed an undergraduate degree and will not be
pursuing a degree at UBC)

I completed my secondary schooling in: ________________________________________

(country)

My most recent or current post-secondary study was completed in: ________________

(country)

CHOICE OF PROGRAM
I apply for the UBC
Vancouver campus
Okanagan (Kelowna) campus

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I wish to enroll in courses at UBC as a visitor and transfer credit back to my home
university:
I apply as “Visiting Student”

I wish to start attending UBC in

Winter (Sept) 20________

I wish to study at UBC for

1 semester
2 semesters

ADDITIONAL INFORMATION

Education Funding Source

Is all or part of your education being funded/paid by an entity/source other than you or
your family? (awards, scholarship, bursaries are not applicable)

For example, a government program or community organization funding. Please note

that students who intend to receive students loans that require repayment after their
study period ends should select 'No' to the following question:
No
Yes
Please select where the funding/payment will originate from:
Aboriginal Community or Organization
Canadian Government or Organization
International Government or Organization
U.S. Government or Organization
Other Sponsoring Organization

APPLICATION COMMENTS
Have you ever been placed on academic probation, failed an academic year, or been
required to withdraw from another college or university?
No
Yes

If you need to clarify or further explain any of the information you have provided in
this application, please do so here (max. 2000 characters). Additional comments are
optional!

Bitte senden Sie Ihre Erläuterung als E-Mail oder Word-Dokument an

[email protected], damit wir diese für Sie online eingeben können ohne alles
abtippen zu müssen. Danke sehr!

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DECLARATION
Please read the following information carefully. You must agree with the declaration
before your application can be submitted to UBC.

Declaration:
• I agree that my secondary and post-secondary grades may be released to UBC.
• I agree to notify Undergraduate Admissions of any additional secondary and/or
postsecondary studies taken or registered courses from which I withdraw
subsequent to the date of this application.
• I certify that any writing samples and any information provided in written
responses are accurate and my own.
• I agree that if I knowingly or carelessly provided untrue, incomplete or plagiarized
information with this application then UBC may in its sole discretion do any or all
of the following: (a) withdraw any offer of admission, whether accepted or not; (b)
require me to withdraw from UBC; (c) subject me to academic discipline; (d) share
the information I provided with other post-secondary institutions, law enforcement
agencies, or other third parties.
• I agree that UBC may verify the information provided by contacting any references
provided and institutions attended.
• I agree that UBC may contact a student's counselor or post-secondary/secondary
school listed in the academic history to collect academic records as relates to
student's evaluation for admissions.
• I agree that UBC may release my name to my school and school district if I am a
Scholarship recipient.
• I agree, if admitted to UBC, to comply with all the rules and regulations of the
University, present and future.
• I agree, that by accepting an award, I authorize The University of British Columbia
to: (i) release to award donors and University faculty and administrative staff my
name, contact information (mailing address, telephone number and email address),
year and program of study, academic average, and other information relevant to the
requirements of the award; (ii) prepare a brief biographical profile to be used for
award presentation ceremonies, publications and the Internet; and (iii) prepare lists
of scholarship and prize winners to be published or included in graduation
ceremonies.

Collection and Use of Personal Information:

Legal Authority: UBC collects, uses, retains and discloses personal information in
accordance with the Freedom of Information and Protection of Privacy Act (FIPPA),
R.S.B.C. 1996, c.165, as amended, and the University Act, R.S.B.C. 1996, c.468, as
amended.

Collection: During the admissions process, and throughout your university career, UBC
will collect personal information from you for the purpose of carrying out its mandate
and operations.

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Use: UBC will use your personal information for the purpose of carrying out its
mandate and operations, including but not limited to the following purposes:
• making decisions about your academic status, including but not limited to
admission,
• registration, and graduation
• providing you with ongoing service and assistance
• operating athletic, residential, alumni and other UBC-related programs and activities
• (including issuing UBC Card and U-Pass)
• other purposes authorized by the FIPPA

Disclosure: UBC may disclose your personal information as follows:

• within UBC to carry out its mandate and operations

• to the UBC Alumni Association for the purpose of registering individuals with the
Association and to allow the Association to communicate with its members
concerning UBC and Association initiatives, including fund-raising and marketing
products and services
• to UBC student societies (UBC Alma Mater Society and UBC Okanagan Students
Union) for the purpose of running elections, managing and communicating with
their
• membership, and administering student programs (including the UBC Alma Mater
Society and Graduate Student Society Health Plan)
• to other UBC student organizations to carry out their mandates
• to other educational institutions when necessary for academic purposes
• to professional organizations for membership and licensing purposes
• to the provincial government to carry out its mandate
• to entities participating in or operating UBC-related programs (e.g., U-Pass)
• to third parties for statistical and research purposes (e.g. to conduct surveys in
order to gain feedback from students regarding their experiences at UBC)
• for other purposes authorized by the FIPPA

For more information, contact the Registrar at the University of British Columbia or the
UBC Vantage College Principal.

Please indicate your acceptance of these terms:

I accept Date: __________________________

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APPLICATION FEE
All applicants must pay the non-refundable application fee. Your application will not be
processed without your signature and application fee.

UBC has applied industry standard security and encryption methods using SSL/TLS on the e-Payment site
[that IEC uses to submit your application] to protect against loss, misuse or alteration of the personal
information you provide; and to ensure that such personal information is only used in accordance with the
Payment Card Industry Data Security Standard. However, no system is impenetrable and in no event will
UBC be liable for your [IEC’s] use of the e-Payment website.
Your private information is secured using SSL (Secure Sockets Layer), the leading security protocol on the
Internet. Information is encrypted and exchanged with an https server.

Method of Payment
Credit Card (recommended payment option)

Please choose one of the following:

Visa
MasterCard
Other: ________________________________________________________________

Total amount to be charged: $ CAD

Cardholder’s name:
Cardholder’s Relationship to
Student (e.g. father, friend, self)
Credit Card Number:
Expiration Date (month/year):
Security Code:

Billing Address (Street & Nr.):

Billing Address (City & Zip
Code):
Billing Address (Country)

Cardholder’s Signature:
By signing above, I authorize the University of British Columbia to charge my
credit card for the amount I have entered above.

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CERTIFICATION
All applicants must sign below! Without your signatures your application cannot be
submitted to UBC.

I certify that the information I have provided in my application documents is complete

and accurate. I understand that failure to disclose correct information may result in the
cancellation of my application or admission.

Important Reminder: Only complete applications will be reviewed.

Student Signature:
City, date (mm/dd/yyyy):

AUTHORIZATION AND THIRD PARTY CONSENT

I hereby permit International Education Centre (IEC Online GmbH - IEC) and its agents
to process my application and submit the information which I have provided in the and
on the application form of the University of British Columbia (UBC) via an electronic
online application system created and maintained by the University of British Columbia.
I also understand that by signing up for the visiting student program, I agree to UBC
sharing my personal and academic information with IEC for enrolment and educational
purposes. UBC is authorized to work with my agent in any way necessary to facilitate
enrolment and my studies.

I consent to the disclosure of information regarding my status and the release of

documents (e.g. letter of acceptance, payment confirmation, and transcript) to IEC
Online GmbH.

Student Signature:
City, date (mm/dd/yyyy):

SUBMIT YOUR APPLICATION WITH ALL REQUIRED DOCUMENTS TO IEC:

IEC Online GmbH
z. Hd. Team Americas
Marienstrasse 19-20
10117 Berlin
Germany

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