Contact Information
Name*
First Last
Preferred Name
First
Email*
Phone*
Date of Birth (dd/mm/yyyy)*
Gender (required for contract)*
As requested by the Private Training Institutions Branch of British Columbia, we are obligated to ask for gender.
- Female
- Male
- Prefer Not to Say
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How did you hear about us?
- Word-of-mouth (friend/family/colleague)
- Social Media
- Organic search (Google)
- Newsletter
Emergency Contact
In the event of an emergency or if we are unable to reach you, we will contact this person for urgent matters.
Emergency Contact Name*
First Last
Relationship*
Phone*
Email*

Application
Deposit:*
Once you submit this application form, please note that there is a $200 non-refundable deposit required to reserve your spot. If you are unsure about the program you want, or if you need more clarification, please contact before filling out this application form.
- Yes, I understand
Intake:*
- January 2023
- May 2023
- September 2023
Invoicing*
if accepted, would you like us to invoice you for the full amount right away?
- No, please invoice me for only the deposit ($200) right away. I understand that the full payment is due prior to the first class.
- Yes, please invoice me for the full amount ($1095).
Student Loans:
As we cannot provide student loans, would you like more information about payment plan options?
- Yes
- No
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CiiAT | Canadian International Institute of Art Therapy

Application Form AIC