Agent Online Application Form

Apply to Brescia

This two-step application form is for students intending to apply only to programs offered at Brescia University College, an affiliated university college of Western University.
If accepted into Brescia University College, all international students will need to obtain a Study Permit and may also require a Temporary Resident Visa through the local Canadian embassy or consulate office. If you are not a Canadian Citizen or Permanent Resident, you should contact the embassy as soon as possible to inquire about the application deadlines and specific requirements. For more information, visit:www.cic.gc.ca/english/study/study.asp

Agent Information

Agent's Name *

(Last name, First name)

Agency Name *

Agent Email *

If the student is being referred by a Brescia partner (e.g. Culture Works, Huron, King's) please indicate below. Please use N/A if Not Applicable.

Referred by:

Applicant Information

First Name *

Last Name *

Street Address *

Apartment/Unit #

City *

Province/State

Country *

Postal/Zip Code *

Home Phone Number *

Mobile Phone

Email Address *

Background Information

Date of Birth *

Country of Citizenship *

If you are a Canadian citizen, please provide proof of citizenship (e.g., passport photo, birth certificate, etc.)

Upload proof of citizenship

Gender *

Female Male

Status in Canada *

English Language Proficiency

First Language *

Start Term *

Previous Western student # (if applicable)

Current Education Level *

*Please consult with an Admission Officer when completing this form

Program and Session Selections *

Optional

Program and Session Selection 2

Optional

Program and Session Selection 3

Thank you for completing step 1 of the application process. Continue to part 2 by clicking "save".

Cancel