Application for Admission

Part-time Undergraduate Studies Application
Mature Student Application
Undecided Application
Bachelor of Education (BEd) in Adult Education Application
Application for all Brock Certificate programs

(Canadian citizens and permanent residents only)

Requested Session:  *  
Student Applicant Information

If you have applied to Brock University before, please provide your Brock Student Number: 
Title *  
Surname *   Former Surname(s)
Given Name *   Commonly Used Name
Middle Name

Marital Status *  
Birthdate (yyyy/mm/dd)
Ontario Education Number  
Citizenship & Language Information
Status in Canada *   Country of Citizenship   *  
Date of Entry
First Language
If "Other", please specify:
Contact Information (location all correspondence should be sent to)
E-mail Address *  
Country *  
Address 1 *  
Address 2
Address 3
City *  
Postal Code or Zip Code
Fax Number
Cell Phone Number
Alternate Phone Number
Permanent Phone Number
Enter the code shown: