If so, you'll see empty fields for those questions.

You won't be able to move to the next section until you answer the questions in the empty fields.

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expand_more Apply to visit, study or work in Canada as a temporary resident create Edit

I want to apply for a: study permit

What exactly do you want to apply for? A study permit to study for more than 6 months

Do you have a provincial attestation letter? Yes

Which province or territory is your provincial attestation letter from? British Columbia

Tell us more about what you'll do in Canada. Include dates. I WILL TAKE ADVANCED STUDY ON THOMPSON RIVERS UNIVERSITY FOR

ACHIEVING BACHELOR OF ART DEGREE. THE PERIOD OF THESE PROGRAM IS

FROM SEPTEMBER 3, 2024 AND WILL BE FINISHED ON AUGUST 3, 2028.

When will you enter Canada? 2024-08-15

When will you leave Canada? 2028-09-02

expand_more Representative create Edit

Are you applying on behalf of someone else? No

expand_more Travel document information of the applicant create Edit

Surname or last name GULTOM

Given name or first name RADJA IMAM

Date of birth 2006-07-10

 Date of expiry of your passport or travel document 2026-04-23

Are you a lawful permanent resident of the United States with a valid No

Green Card (alien registration card)?

Have you held a Canadian visitor visa in the past 10 years? No

Do you currently hold a valid U.S. nonimmigrant visa? No

Are you travelling to Canada by air? Yes

expand_more Citizenship and places where the applicant has lived create Edit

Country or territory where you were born Indonesia

City or town where you were born JAKARTA

Are you a citizen of more than one country or territory ? No

Which country or territory are you a citizen of? Indonesia

I am a citizen of this country or territory since birth check_box

Since what date are you a citizen of this country or territory? 2006-07-10

expand_more National identity document of the applicant create Edit

Do you have a valid national identity document? Yes

Document number 3174041007060003

Confirm your document number 3174041007060003

Date of issue 2024-06-21

Select the country or territory that issued this document Indonesia

 Select a country or territory Indonesia

What is your status in your country or territory of residence? Citizen

From 2006-07-10

This is where I currently live. check_box

expand_more Biometrics (fingerprints and photo) of the applicant create Edit

Do we already have your fingerprints and photo (biometrics), and are No

they still valid?

expand_more Application for a study permit create Edit

Type of study permit I have a letter of acceptance from a designated learning institution

Which of the following applies to you? None of the above apply to me.

Level of study University - Bachelor's Deg.

Designated Learning Institution (DLI) number O19395299610

Name of school Thompson Rivers University

Select a country or territory Canada

Street number 805

Street name TRU Way

City or town Kamloops

Province British Columbia

Postal code V2C 0C8

 Are you receiving financial support for your studies? No

expand_more Co-op programs for foreign students create Edit

Do you want to apply for a work permit to participate in a co-op No

program?

expand_more Information about education, work and other activities create Edit

Have you ever studied at a post-secondary school (university, college or No

vocational school)? You don't need to have completed a degree or

diploma.

expand_more Medical background questions create Edit

Have you had a medical exam performed by an IRCC authorized panel No

physician (doctor) within the last 12 months?

expand_more Medical background questions- Tuberculosis create Edit

In the last 2 years, were you diagnosed with tuberculosis? No

In the last 5 years, have you been in close contact with a person with No

tuberculosis?

expand_more Medical background questions create Edit

Are you currently receiving dialysis treatment? No

Have you had a drug or alcohol addiction causing you to be a threat to No

yourself or others, or to be hospitalized?

Have you had a mental health condition causing you to be a threat to No

yourself or others, or to be hospitalized?

 Given name or first name SAHRUN

Relationship Father

Date of birth 1968-11-13

Country or territory of birth Indonesia

Present occupation SOLDIERS OF INDONESIAN MILITARY FORCES

Does this parent have the same address as you? Yes

Will this parent come with you to Canada? No

Surname or last name HANDAYANI

Given name or first name SRI

Relationship Mother

Date of birth 1967-05-20

Country or territory of birth Indonesia

Present occupation CIVIL SERVANT

Does this parent have the same address as you? Yes

Will this parent come with you to Canada? No

expand_more Language of the applicant create Edit

What is your native language or mother tongue? Indonesian

Can you communicate in English and/or French? English

 Telephone number 81399083330

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Date modified: 2024-04-15 4fe1fbba3

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