KOM REGISTRATION FORM
Fill out and print this page or download the Adobe Acrobat document, complete and send (along with $70.00) to KOM to start the application process.
Last Name:
Given Names:
Date of Birth (DD/MM/YY):
Street Number: Street Name:
 P0 Box: Apt Number:
City:   Province:
Postal Code:  
Telephone:    Cell Phone:
Email:
Country of Birth:          Citizenship:  
Teaching Applicants: Primary: Secondary:
Teaching Subject Major: Teaching Subject Minor:
Other Program of Choice:
Proposed Year AND Month of Entry:
University Choice 1:
University Choice 2:
 
Official Transcripts Provided: Yes No

Current Degree of Study:
Current Institution of Study Diploma/Degree Completion Date (DD/MM/YY):

By completing and submitting this KOM Registration form, you will give consent to the collection, use and disclosure to only the relevant parties involved within the application process of KOM Consultants.
I do not want any  information relevant to my file to be given to any family members.

I do not want my name, phone number and email address to be put on a student list for students who will be attending the same program and university, once I have paid fees and confirmed enrolment.
Mail this form with a non-refundable processing fee of $70.00 (Check or Money Order) to:
K.O.M. Consultants , P.O. Box 60524, Mountain Plaza Postal Outlet, Hamilton, ON L9C 7N7