IIT Academy Student Application Form 12345678 Student DetailsFirst Name(Required) First Middle Name Middle Last Name(Required) Last Date of Birth(Required)Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031Gender(Required) Male Female Grade Requesting(Required)Junior KindergartenSenior KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8School Year Requesting(Required)For JK applicants, students need to be age 4 or turning 4 by December of the year that they are applying for. 2022202320242025202620272028Current Grade(Required)N/AJunior KindergartenSenior KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Present School(Required) Does the applicant have any siblings enrolled at the IIT Academy already? Yes No If you answered "Yes" to the above question, please provide their name(s) and grade(s) if there are multiple siblings. Resident & Contact InformationAddress(Required) Street Address Address Line 2 City State / ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone Number(Required) Primary Parent InformationPrimary Parent First Name(Required) First Primary Parent Last Name(Required) Last Primary Parent Phone Number(Required)Primary Parent Email(Required) Would You Like To Provide Secondary Parent Information?(Required) Yes No Secondary Parent InformationSecondary Parent First Name First Secondary Parent Last Name Last Secondary Parent Phone NumberSecondary Parent Email Applicant's InformationThis section is for the person who is filling out and submitting the form.Applicant Full Name First Last Applicant Email Guardian InformationGuardian's First Name First Guardian's Last Name Last Guardian's Email Guardian's Residential Phone NumberGuardian's Cell Number Document UploadPlease upload the following documents 1. Copy of Birth Certificate 2. Copy of TWO most recent report cards (if applying for SK to Grade 8) You may upload more than one document at a time through the file upload link below. Please Do Not Upload Any SIN or Health Card documents. File Drop files here or Select files Accepted file types: jpg, jpeg, png, pdf, docx, doc, Max. file size: 16 MB. Payment DetailsRegistration Fee (Non-Refundable)(Required) Price: Payment Information(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Total NameThis field is for validation purposes and should be left unchanged.
