graduate | YORK BLU tite" ntti” Sac Ontario Visiting Graduate Student Application Review information on page two before completing this form. Simmame Cirone_ 2 — ‘Student number Email Aoiarsosy | Vieter. Cir Crone 6 Gmail Nod Froaram Dearee & level of study rent status Aim Humanities = please select - Ph 1D - please select - Fun tne ‘Mailing address a chy peeereeremeeumnesneses [Postal code | Province [1€ Saint fabric St, unit 122 Torevto M57 3K | On Date of birth (mm/dd! yyy) Phone number | }/ae 71964 [647 Feo WM | Thereby request permission to take the following courses required for my degree at: Host University _ Host program [University o& Torente | fe tia on __| From the period beginning (month/ year) For the period ending (month/ year) ontIy loz /I¢ fe eae RLG 260HIF [Ditre by Sanskord RLGABHIS —|Datrw be Seskot T ‘udent: Attach a copy of the course description and a concise rationale for how the course(s) fit(s) your plan of study. st kane ‘(mmiyyyy) | Sudent number at Host university Rus epaon datw at eur U gol aeot ee [99636019 a | Date (mma yyyy) ‘Student signati re erin a LoS | 03/2017 \vacy: Personal information in connection with this form is elected under the authority of The York Lhiversty Act, 1965 and will be used for educationa, administrative and saitical purposes. If you have any questions about the colletion, use and disclosure of personal information by York Unversity, please ‘contac: Faaily of raduate Susies, 230 York Lanes, (416)79-2100 x SBD1. tots Ontario Waiting Gradua